Treatments for Trigeminal Neuralgia

Treatment for trigeminal neuralgia usually begins with medication. This proves to be sufficient in many cases. However, some people stop responding to medication over a period of time. In such cases, injections and surgery are the other available alternatives.

Medications help to block the transmission of pain signals to the brain. They are commonly used as an initial form of treatment and include:

  • Anticonvulsants: The most commonly prescribed and effective drug is the anticonvulsant carbamazepine (Tegretol, Carbatrol). Other anticonvulsants used are phenytoin (Dilantin), gabapentin (Neurontin) and oxcarbazepine (Trileptal). Side effects of these medications include dizziness, drowsiness, confusion, double vision and nausea.

Some people, especially those of Asian descent, have a serious intolerance for carbamazepine. They may require further testing before being prescribed this drug. The anticonvulsant prescribed may lose its effectiveness after a period of time. In such cases the neurologist may increase the dose or switch to another type of medication.

  • Antispasmodics: Drugs like baclofen (Lioresal, Liofen) are sometimes prescribed either singly or in combination with carbamazepine or phenytoin. Side effects include drowsiness, confusion and nausea.

If medications lose their effectiveness, your neurologist may consider alternative treatments. Alcohol injections are sometimes used to provide pain relief, albeit temporarily, to the affected area of the face. These injections temporarily numb the affected area of the face and need to be repeated periodically. The danger is that they may cause damage to the nearby nerves. Other side effects of this procedure include bleeding and infection at the injection site.Surgery can be considered, usually as a last resort. The aim of surgery is to relieve pressure on the trigeminal nerve or to damage the nerve enough so that it stops functioning. This may result in permanent facial numbness, but the pain may also return again at a later date.There are different surgical procedures for trigeminal neuralgia. They include:

  • Gamma-Knife Radiosurgery (GKR):The procedure uses a focused dose of high intensity radiation on the root of the trigeminal nerve. The procedure is becoming more popular today due to its safety and effectiveness. The radiation is used to damage the trigeminal nerve so as to reduce or eliminate the pain. Relief is gradual, often taking several weeks to begin. In most cases, people experience complete relief from the pain. In case of recurrence at a later date, the procedure can be repeated. Side effects include a permanent loss of sensation but typically affect fewer than 5% of all cases.
  • Microvascular Decompression (MVD):This is a procedure used to remove or relocate blood vessels that are exerting pressure on the trigeminal nerve. During this procedure the neurosurgeon will make an incision behind the ear. A small hole is then drilled into the skull through which the trigeminal nerve can be accessed. The blood vessel in contact with the nerve is then directed away from the nerve and a pad is placed between the nerve and the blood vessel. If the errant blood vessel is a vein, then it is usually removed.

MVD can reduce or eliminate the pain in most cases and has a high success rate. However, there is a chance that the pain may recur in some cases. The risks associated with this procedure are slight but they include decreased hearing, double vision, stroke or even death.

  • Glycerol Injection: This procedure involves the insertion of a needle through the face. The needle is guided into the trigeminal cistern which is a small sac of cerebrospinal fluid that surrounds the trigeminal nerve ganglion. The precise location of the needle is confirmed using imagery and a small amount of sterile glycerol is injected. The glycerol damages the trigeminal nerve, thereby blocking the pain signals. Most people experience relief from the pain. The pain does recur in some cases and there have been many instances of people experiencing facial numbness.
  • Balloon Compression: In this procedure, a hollow needle is inserted through the face into an opening at the base of the skull. A catheter with a balloon at its end is threaded through the needle. The balloon is then inflated, causing damage to the trigeminal nerve and blocking pain signals. However, most people experience some degree of facial numbness and the pain tends to recur after a while.
  • Radiofrequency Thermal Rhizotomy: This procedure involves the destruction of the nerves that transmit the pain signals. Upon sedation, the neurosurgeon inserts a hollow needle through the face into an opening in the skull. The needle is positioned at the root of the trigeminal nerve. The electrode is then heated until it damages the nerve fibers. This procedure almost always causes some facial numbness.
  • Rhizotomy: This is a surgical process involving cutting a part of the trigeminal nerve at its root. The procedure is similar to an MVD and is performed when the neurosurgeon has not found any blood vessel exerting pressure on the trigeminal nerve. This procedure permanently numbs the side of the face.

The National Institute of Neurological Disorders and Stroke (NINDS) is pursuing a research program into newer, more effective treatments for pain and nerve damage. Their stated goal is the reversal of debilitating conditions like trigeminal neuralgia.

Frequently asked questions
  2. James K Liu, Ronald I Apfelbaum, Treatment of trigeminal neuralgia, Neurosurgery Clinics of North America, Volume 15, Issue 3, July 2004, Pages 319-334, ISSN 1042-3680, 10.1016/