How is trigeminal neuralgia treated?

Dr. Jeanne Morrison, PhD
Family Practitioner

Treatment options for TN include medicines, surgery and complementary approaches.

Anticonvulsant medicines—used to block nerve firing—are generally effective in treating trigeminal neuralgia (TN). These drugs include carbamazepine, oxcarbazepine, topiramate, clonazepam, phenytoin, lamotrigin and valproic acid. Gabapentin or baclofen can be used as a second drug to treat TN and may be given in combination with other anticonvulsants.

Tricyclic antidepressants, such as amitriptyline or nortriptyline, are used to treat pain described as constant, burning or aching. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects, such as excess fatigue, surgical treatment may be recommended.

Several neurosurgical procedures are available to treat TN. The choice among these depends on the patient's preference, physical well-being, previous surgeries, presence of multiple sclerosis and area of trigeminal nerve involvement (particularly when the upper/ophthalmic branch is involved). Some procedures are done on an outpatient basis, while others may involve a more complex operation that is performed under general anesthesia. Some degree of facial numbness is expected after most of these procedures, and TN might return despite the procedure's initial success. Depending on the procedure, other surgical risks include hearing loss, balance problems, infection and stroke.

Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These therapies offer varying degrees of success. Options include acupuncture, biofeedback, vitamin therapy, nutritional therapy and electrical stimulation of the nerves.

This answer is based on source information from the National Institute of Neurological Disorders and Stroke.

Treatment options for trigeminal neuralgia include medications or surgeries.

Treatment of trigeminal neuralgia consists of medical and surgical approaches. Initially, the patient is offered treatment with anticonvulsants, such as carbamazepine or oxcarbazepine, which may be quite effective in the early stages. However, the side effects such as sedation, dizziness and unsteadiness may limit the use of these medications.

Approximately 50 percent of patients who get initial relief with medications eventually will need surgical therapy for their trigeminal neuralgia. The two most popular procedures are: gamma knife radiosurgery and micro vascular decompression. Gamma knife radiosurgery causes partial radiation injury to the trigeminal nerve and is entirely noninvasive, outpatient and painless. The main disadvantage is that the therapeutic effect is delayed by up to two months. The sensation to the face may be impaired in small percentage of patients. Micro vascular decompression is a major neurosurgical procedure, which is performed through a small opening in the back of the skull. The effect of the treatment is immediate and there is no risk of sensory loss the face.

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