Anticonvulsant medications are typically prescribed instead of traditional painkillers (such as non-steroidal anti-inflammatory drugs), which are not as effective at blocking the electrical signals from the misfiring neurons that are causing the sensations of pain. [2] X Research source Carbamazepine is the usual initial anticonvulsant medication treatment since it’s been studied the most. You may experience drowsiness, dizziness, nausea, and vomiting as side effects, but they may not be as prominent if you start with a lower dose and titrate up slowly. [3] X Research source Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ. 2015 Mar 12;350:h1238 Oxcarbazepine is similar to carbamazepine in effectiveness and may be better tolerated, but is more expensive. Gabapentin and lamotrigine are often used for patients who cannot tolerate carbamazepine. Baclofen may be a useful medication to take alongside the anticonvulsant, particularly in patients with TN related to multiple sclerosis. Anticonvulsant medications may lose their efficacy over time as they build up in the bloodstream; at this point, your doctor may switch your prescription to a different anticonvulsant that your body has not grown insensitive to or use adjunct therapy with another medication such as lamotrigine. [4] X Trustworthy Source Mayo Clinic Educational website from one of the world’s leading hospitals Go to source
Tricyclic antidepressants are often effective in managing chronic pain conditions, such as atypical facial pain, but are not generally useful in classical trigeminal neuralgia. Tricyclic antidepressants tend to be prescribed in lower doses for chronic pain management versus when they are used to treat depression. [6] X Research source Common tricyclic antidepressants used to treat chronic pain include amitriptyline and nortriptyline. [7] X Research source
TN2 consists of constant pain that can be dampened by these medications as they build up in the bloodstream, while TN1 consists of sharp recurring pain episodes that cannot effectively be lessened by these drugs. Your doctor can prescribe analgesics and opioids such as allodynia, levorphanol, or methadone.
Antispasmodics, otherwise known as muscle relaxants, are prescribed to treat trigeminal neuralgia because they inhibit involuntary muscle movements that can be triggered by misfiring neurons during a trigeminal neuralgia episode. Common antispasmodics include Kemstro, Gablofen, and Lioresal; these are all members of the baclofen family of drugs.
Botox may be effective for pain management in patients with trigeminal neuralgia, especially those with rapid muscle twitching, but there have not been many studies to know the results. [11] X Research source Many people feel uncomfortable considering Botox injections due to negative connotations from their use in plastic surgery; however, you should not discount this treatment modality because it can effectively help you to manage your chronic facial pain after you have exhausted your other options. Botox injections may be beneficial for patients that have medically refractory trigeminal neuralgia, though there isn’t a lot of data. [12] X Research source A new treatment paradigm for trigeminal neuralgia using Botulinum toxin type A. Guardiani E, Sadoughi B, Blitzer A, Sirois D. Laryngoscope. 2014;124(2):413.
Your doctor will work with you to help you choose the best surgery based on your health and medical background. The degree of severity of your trigeminal neuralgia, prior history of neuropathy, and general health all factor into the options that are available to you. The overall goal of surgery is to minimize damage to the trigeminal nerve as trigeminal neuralgia advances and to improve quality of life when medications no longer effectively manage pain.
During the procedure, a small balloon is inserted into the skull through a catheter and as it inflates, the trigeminal nerve is pressed against the skull. This is typically an outpatient procedure that is performed under general anesthesia, although sometimes an overnight hospital stay is needed. Balloon compression results in about two years of pain relief. Many patients experience temporary facial numbness or weakness in muscles used for chewing after undergoing this procedure, but are generally relieved of pain symptoms. [15] X Trustworthy Source Mayo Clinic Educational website from one of the world’s leading hospitals Go to source
During this outpatient procedure, a thin needle is inserted through the cheek into the base of the skull and near the 3rd division of the trigeminal nerve. Once the glycerol is injected, it damages the trigeminal nerve, resulting in pain relief. This procedure usually results in about 1 to 2 years of pain relief.
During the procedure, a needle with an electrode is inserted into the trigeminal nerve. Once the area of nerve that causes the pain is located, your doctor sends small electrical pulses through the electrode to damage the nerve fibers, resulting in numbing of the site. In about 50% of the patients, the symptoms reoccur three to four years following the procedure.
During the procedure, the radiation creates a lesion of the trigeminal nerve, which disrupts sensory signals to the brain and reduces pain. Patients can often leave the hospital the same day or the day following the procedure. Most patients who undergo gamma knife report pain relief after a few weeks or months but pain often reoccurs within three years.
The recovery time for this procedure varies from person to person and often requires a hospital stay. This is the most effective surgical treatment for trigeminal neuralgia. About 70-80% of patients have immediate, complete pain relief and 60-70% remain pain-free at 10-20 years. [16] X Research source Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ. 2015 Mar 12;350:h1238.
Neurectomies may work for treating trigeminal neuralgia, but most evidence has been negative or inconclusive. Neurectomies are often performed when a blood vessel is not found pressing on the nerve during an MVD. During the procedure, different portions of the trigeminal nerve’s branches are removed to grant pain relief.
