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Your QuestionHow is trigeminal neuralgia treated? What is the long-term outlook for individuals with this condition?
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Trigeminal neuralgia is a nerve disorder that causes a stabbing or electric-shock-like pain in parts of the face. The pain lasts a few seconds to a few minutes, and usually on only one side of the face. It can also cause muscle spasms in the face the same time as the pain. The pain may result from a blood vessel pressing against the trigeminal nerve (the nerve that carries pain, feeling, and other sensations from the brain to the skin of the face), as a complication of multiple sclerosis, or due to compression of the nerve by a tumor or cyst. In some cases, the cause is unknown. Treatment options include medicines, surgery, and complementary approaches.
Treatment options include medicines, surgery, and complementary approaches.
Anticonvulsant medicines—used to block nerve firing—are generally effective in treating trigeminal neuralgia. These drugs include carbamazepine, oxcarbazepine, topiramate, clonazepam, phenytoin, lamotrigine, and valproic acid. Gabapentin or baclofen can be used as a second drug to treat trigeminal neuralgia and may be given in combination with other anticonvulsants.
Tricyclic antidepressants such as amitriptyline or nortriptyline are used to treat pain described as constant, burning, or aching. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by trigeminal neuralgia. If medication fails to relieve pain or produces intolerable side effects, surgical treatment may be recommended.
Several neurosurgical procedures are available to treat trigeminal neuralgia. The choice among the various types depends on the patient's preference, physical well-being, previous surgeries, presence of multiple sclerosis, and area of trigeminal nerve involvement. Some procedures are done on an outpatient basis, while others may involve a more complex operation that is performed under general anesthesia. Some degree of facial numbness is expected after most of these procedures, and trigeminal neuralgia might return despite the procedure’s initial success. Depending on the procedure, other surgical risks include hearing loss, balance problems, infection, and stroke.
A rhizotomy is a procedure in which select nerve fibers are destroyed to block pain. A rhizotomy for trigeminal neuralgia causes some degree of permanent sensory loss and facial numbness. Several forms of rhizotomy are available to treat trigeminal neuralgia:
Balloon compression works by injuring the insulation on nerves that are involved with the sensation of light touch on the face.
Glycerol injection involves bathing the ganglion (the central part of the nerve from which the nerve impulses are transmitted) and damaging the insulation of trigeminal nerve fibers.
Radiofrequency thermal lesioning involves gradually heating part of the nerve with an electrode, injuring the nerve fibers.
Stereotactic radiosurgery uses computer imaging to direct highly focused beams of radiation at the site where the trigeminal nerve exits the brainstem. This causes the slow formation of a lesion on the nerve that disrupts the transmission of pain signals to the brain.
Microvascular decompression is the most invasive of all surgeries for trigeminal neuralgia, but it also offers the lowest probability that pain will return. While viewing the trigeminal nerve through a microscope, the surgeon moves away the vessels that are compressing the nerve and places a soft cushion between the nerve and the vessels. Unlike rhizotomies, there is usually no numbness in the face after this surgery. A neurectomy, which involves cutting part of the nerve, may be performed during microvascular decompression if no vessel is found to be pressing on the trigeminal nerve.
Some patients choose to manage trigeminal neuralgia using complementary techniques, usually in combination with drug treatment. These therapies offer varying degrees of success. Options include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves.
More detailed information regarding the management of trigeminal neuralgia can be found through the National Institute of Neurological Disorders and Stroke and eMedicine.
- Patient information: Trigeminal neuralgia (The Basics). UpToDate. Waltham, MA: UpToDate; 2016; Accessed 2/17/2016.
- Dugdale DC, Hoch DB. Trigeminal neuralgia. MedlinePlus. 2010; http://www.nlm.nih.gov/medlineplus/ency/article/000742.htm. Accessed 9/13/2010.
- Trigeminal Neuralgia Fact Sheet. National Institute of Neurological Disorders and Stroke (NINDS). 2010; http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/detail_trigeminal_neuralgia.htm. Accessed 9/13/2010.
- Singh MK, Campbell GH, Lutsep HL, Gautam S. Trigeminal Neuralgia: Follow-up. eMedicine. 2009; http://emedicine.medscape.com/article/1145144-followup. Accessed 9/13/2010.