What's the treatment for trigeminal neuralgia?
It is not easy to treat trigeminal neuralgia. Pain can be suppressed by a range of medicines, including the anti-epilepsy medicines carbamazepine (Tegretol) or phenytoin (Dilantin). These drugs slow down the nerve signals at certain nerve terminals, which eases the pain. However, these drugs cause a wide range of side effects, including nausea, dizziness, drowsiness, liver problems, and skin allergies. Some people develop resistance to the drugs or they can't tolerate the
high dosage needed to control the discomfort. If the medicines are stopped, the pain usually returns.
The first treatment for trigeminal neuralgia usually is carbamazepine (Tegretol and others). Carbamazepine is an anticonvulsant medication that decreases the ability of the trigeminal nerve to fire off the nerve impulses that cause facial pain. If carbamazepine is not effective, other possible drug choices include phenytoin (Dilantin), baclofen (Lioresal), gabapentin (Neurontin), lamotrigine (Lamictal), clonazepam (Klonopin) and valproic acid (Depakene, Depakote). These may be taken individually or in combination. One study found that when trigeminal neuralgia is related to multiple sclerosis, misoprostol (Cytotec), a medication usually prescribed to prevent stomach ulcers, may be effective. Narcotic pain relievers, such as oxycodone (OxyContin) or morphine (several brand names), may be recommended briefly for severe episodes of pain. Some of these medications carry the risk of unpleasant side effects, including drowsiness, liver problems, blood disorders, nausea, dizziness, overgrowth of the gums and skin rashes. For this reason, people taking any of these medications may be monitored with frequent follow-up visits and periodic blood tests. After a few pain-free months, your doctor may attempt to decrease the dose of the medication gradually or discontinue it. This is done to limit the risk of side effects and to determine whether your trigeminal neuralgia has gone away on its own.
If drug treatment fails, surgical treatment to block pain signals from the nerve may be effective. Radio-frequency waves, gamma rays, or glycerol injections can deaden the nerve (and hence the pain). An operation that frees the nerve from whatever is compressing it (blood vessel or tumor) can permanently relieve pain, but this major neurosurgical procedure carries its own risks and complications. Alternatively, a new procedure seeks to place a cushioning sponge between the nerve and a pulsating artery wrapping around it to soothe the irritated nerve.