What Are the Treatments for Trigeminal Neuralgia?

Trigeminal neuralgia is face pain that usually occurs on one side of the face. Pain can be triggered by a light touch or while doing everyday things such as eating, talking or brushing the teeth. It can come and go, with long periods of being pain-free. The first treatment for trigeminal neuralgia is typically prescription medication. If pain persists or worsens, surgery may be needed.

Medication

• Trigeminal neuraligia treatment begins with anticonvulsant and antidepressant medications. Anticonvulsant medicines include carbamazepine, topiramate and clonazepam. This type of drug blocks the misfiring of the trigeminal nerve. Baclofen, a muscle relaxant, can be used in combination with other medications to prevent muscle spasms. Antidepressants are used to treat the burning, aching pain of trigeminal neuralgia. Pain that is severe or recurring may be treated with opioids or analgesics such as NSAIDs.

Rhizotomy

• Rhizotomy is a surgical procedure that destroys specific nerve fibers to block pain. This treatment can cause permanent sensory loss and facial numbness. There are several types of rhizotomy the surgeon can choose from, which include balloon compression, glycerol injection, radiofrequency thermal lesioning and sterotactic radiosurgery.

  Balloon compression is used to damage the insulation on the trigeminal nerve and is performed under general anesthesia. Glycerol injection is an outpatient procedure. The physician injects glycerol into the ganglion where the trigeminal nerves meet at the base of the skull. Radiofrequency thermal lesioning uses electrical current to damage the nerve fibers and stop pain. Sterotactic radiosurgery is a computer-imaging procedure that uses radiation beams to form a lesion on the trigeminal nerve that disrupts pain signals.

Microvascular Decompression

• This procedure as a treatment for trigeminal neuralgia is the most invasive. It's performed under general anesthesia and requires a stay of several days in the hospital. This surgical treatment is done by placing a cushion between the trigeminal nerve and nearby vessels so the nerve is no longer being compressed. A neurectomy may be done during this procedure if the surgeon does not find any vessels pressing on the nerve. He will cut part of the trigeminal nerve to stop the pain signals from reaching the brain.

Gamma Knife Radiosurgery

• This treatment for trigeminal neuralgia uses focused beams of radiation to create a lesion on the root of the nerve that develops slowly over time and disrupts the pain signals from the nerve to the brain. This procedure is an option for someone who cannot be put under general anesthesia due to underlying medical conditions.

Linear Accelerator Radiosurgery

• Linear accelerator radiosurgery (LINAC) uses radiation called high-energy X-rays, which are delivered in a sequence of repeated bursts. This procedure targets the nerve and damages it, causing a lesion to develop slowly and disrupt pain signals from being transmitted to the brain.