How is trigeminal neuralgia (TN) treated?

Several options can be used to treat TN. These include medications, surgery, and complementary therapies.

Medications

  • Anticonvulsant drugs: An anticonvulsant drug called carbamazepine is usually the first choice for treating pain associated with typical TN. Other anticonvulsant drugs that may be prescribed include oxycarbamazepine, phenytoin, lamotrigine, sodium valproate, gabapentin, clonazepam, and toprimate.
  • Other medications: Tricyclic antidepressants such as amitriptyline or nortriptyline are used to treat symptoms associated with atypical trigeminal neuralgia. Baclofen is a muscle relaxant that may be used alone or along with carbamazepine or phenytoin. Botulinum toxin injections may be used to block sensory nerves. Nerve blocks are also used in some instances to provide temporary relief.

Surgery

Patients who do not respond to drug therapy or whose condition worsens over time may be candidates for surgery. Several procedures are used to treat TN, depending on the severity of the pain, the patient’s preference, physical health, previous surgeries, and surgeries’ relative risks and benefits.

Percutaneous (through the skin) surgical techniques include

  • Balloon compression: A surgeon passes a needle through the cheek to the trigeminal nerve. A catheter with a small balloon is inserted through the needle. The balloon is inflated and compresses the nerve, injuring the pain-causing fibers. The balloon and catheter are removed at the end of the procedure.
  • Glycerol injection rhizotomy: Glycerol is injected through a needle into the area where the nerve divides into three main branches. The procedure causes selective nerve damage that disrupts the transmission of pain signals to the brain.
  • Stereotactic rhizotomy: Nerve pain is relieved using heat to destroy part of the nerve that causes pain. The surgeon passes a hollow needle through the cheek into the trigeminal nerve. A heating current is passed through an electrode to destroy some of the nerve fibers.

Open (invasive) surgical procedures include

  • Microvascular decompression: Decompression may reduce sensitivity and allow the trigeminal nerve to recover and return to a more normal, pain-free state. Generally, it is the most effective method to treat TN. However, it is also the most invasive because an opening must be made in the skull to expose the trigeminal nerve root. The surgeon can then locate the blood vessel that may be compressing the nerve and gently move it away from the point of compression. Microvascular decompression is associated with relief of symptoms in over 70% of patients after 10 years. Younger patients who are otherwise in good health are suitable candidates for the procedure.

Stereotactic radiosurgery includes

  • Radiation procedures: Gamma Knife, Cyberknife or LINAC surgery deliver a single, highly concentrated amount of ionizing radiation to a precise target at the trigeminal nerve root. Over a period of time a lesion forms in the nerve that disrupts transmission of pain signals to the brain.

Complementary therapies

Other approaches that may be used in conjunction with drug therapy include:

  • Yoga
  • Creative visualization
  • Meditation
  • Aroma therapy
  • Low-impact exercise

Additional therapies that may be helpful include:

  • Acupuncture
  • Chiropractic
  • Supportive counseling or therapy
  • Biofeedback
  • Vitamin therapy
  • Nutritional therapy

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