What treatment options exist for trigeminal neuralgia?
The treatment for trigeminal neuralgia is usually medication to reduce the symptoms. Other options, including surgery, are considered if medication isn't very effective.
Medicines for trigeminal neuralgia
Carbamazepine is the usual treatment
Carbamazepine is normally used to treat epilepsy. Trigeminal neuralgia isn't epilepsy. However, the effect of carbamazepine is to quieten nerve impulses and it often works well for trigeminal neuralgia. There is a good chance that carbamazepine will ease symptoms of the condition within 1-2 days. You should then take it regularly to prevent the pain from returning. The dose of carbamazepine needed to control the pains varies from person to person.
It is common to take carbamazepine until about a month after the pains have stopped. The dose may then be reduced gradually and stopped if possible. After this, there is often a period when pains do not occur for some time (remission). However, the pains are likely to return at some time in the future. Treatment can then be restarted. Some people find that carbamazepine works well at first but less well over the years.
Other medicines may be tried if carbamazepine does not work well or causes bad side-effects. These include medicines that quieten nerve impulses - for example, gabapentin, oxcarbazepine, baclofen or lamotrigine. A combination of two medicines is occasionally tried if one alone does not help.
Normal painkillers such as paracetamol or codeine do not work for trigeminal neuralgia.
Deep brain stimulation
If you have really severe trigeminal neuralgia which has not responded to medication, you may be offered this treatment. It involves delivering an electrical pulse to a part of the brain, using a probe. A scanning technique - usually MRI or computed tomography (CT) - is used to make sure the probe is in the right place. Because the treatment is relatively new, the risks and benefits are still under investigation and you are likely to be offered it as part of a research trial.
Surgical options for treatment
An operation is an option if medication does not work or causes troublesome side-effects. Surgery for trigeminal neuralgia falls into two categories:
This means an operation to relieve the pressure on the trigeminal nerve. An operation can ease the pressure from the blood vessel (decompress the nerve) and therefore ease symptoms. This operation has the best chance of long-term relief of symptoms. However, it is a major operation involving a general anaesthetic and brain surgery to get to the root of the nerve within the brain. Although usually successful, there is a small risk of serious complications, such as a stroke or deafness, following this operation.
Ablative surgical treatments
Ablative surgery is a procedure which destroys tissue in the body. There are various procedures that can be used to destroy the root of the trigeminal nerve and thus ease symptoms. For example, one procedure is gamma knife surgery (called stereotactic radiosurgery). This uses radiation targeted at the trigeminal nerve root to destroy the nerve root.
The advantage of these ablative procedures is that they can be done much more easily than decompression surgery as they do not involve formal brain surgery. So, there is much less risk of serious complications or death than there is with decompression surgery. However, there is more of a risk that you will be left with a lack of sensation in a part of your face or eye. Also, there is a higher chance that the symptoms will return at some stage in the future, compared with decompression surgery.
Further reading and references
Trigeminal neuralgia; NICE CKS, December 2014 (UK access only)
Deep brain stimulation for intractable trigeminal autonomic cephalalgias; NICE Interventional Procedure Guideline, March 2011
Montano N, Conforti G, Di Bonaventura R, et al; Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag. 2015 Feb 2411:289-99. doi: 10.2147/TCRM.S37592. eCollection 2015.
Zakrzewska JM, Linskey ME; Trigeminal neuralgia. BMJ. 2014 Feb 17348:g474. doi: 10.1136/bmj.g474.
Zhang J, Yang M, Zhou M, et al; Non-antiepileptic drugs for trigeminal neuralgia. Cochrane Database Syst Rev. 2013 Dec 312:CD004029. doi: 10.1002/14651858.CD004029.pub4.
Parmar M, Sharma N, Modgill V, et al; Comparative Evaluation of Surgical Procedures for Trigeminal Neuralgia. J Maxillofac Oral Surg. 2013 Dec12(4):400-409. Epub 2012 Nov 29.
Hi this is my first post. I am a 66 yr old woman in Australia and would like some advice? Is there a "natural" old fashioned remedy for trigeminal neuralgia. I am having severe pain on the left side...sheilagh46696
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