This is a multicenter, prospective, randomized, controlled trial. A total of 165 patients with idiopathic trigeminal neuralgia will be enrolled and randomly divided into three groups at a 1:1:1 ratio. The aim is to compare the efficacy and safety of conventional carbamazepine monotherapy, carbamazepine combined with oral antiviral therapy, and carbamazepine combined with anti-inflammatory therapy in pain relief, quality of life improvement and adverse event profiles.

Idiopathic trigeminal neuralgia is a severe neuropathic pain disorder. Carbamazepine is the first-line conventional treatment, but some patients have insufficient pain relief or intolerable side effects. Viral latent infection and neuroinflammation are considered potential pathogenesis of trigeminal neuralgia. This study intends to explore whether adding oral antiviral agent (acyclovir) or non-steroidal anti-inflammatory drug (celecoxib) can further improve pain control, reduce carbamazepine consumption, improve mood status and quality of life, and ensure clinical safety. All participants will receive 12-week standardized treatment and follow-up at 1 week, 2 weeks, 1 month, 3 months and 6 months after enrollment.

Inclusion Criteria:

1. Diagnosed with idiopathic trigeminal neuralgia according to standard clinical criteria.
2. No secondary etiology confirmed by cranial imaging.
3. No severe systemic disease or immune system disease.
4. Voluntary participation and signed informed consent.

Exclusion Criteria:

1. Secondary trigeminal neuralgia of any cause.
2. Active herpes zoster infection recently.
3. Severe hepatic or renal insufficiency or contraindications to study drugs.
4. Unable to complete questionnaire evaluation independently.
5. Pregnancy or lactation state. -

Individual participant data (IPD) will not be shared publicly due to institutional data privacy regulations and patient confidentiality requirements. Data availability is limited to the research team and authorized institutional review personnel only.