Trigeminal Neuralgia Blog: Treatment Options
What Can Help?
Treatment options include different medications and procedures. The first step is using medications to treat trigeminal neuralgia. Carbamazepine is the medication that is most often used to treat the pain because it is known to be the most effective medication available for this pain.
As time goes on, the medications may not treat the pain as it did before or more of the medication may be needed. The next step is evaluation for surgical options. The most common surgical procedures for trigeminal neuralgia are microvascular decompression, radiofrequency lesion, and radiosurgery. Balloon compression and glycerol injection are less common surgical options.
The most common medications used to treat trigeminal neuralgia are:
- Carbamazepine (Tegretol)
- Gabapentin (Neurontin)
- Phenytoin (Dilantin)
- Pregabalin (Lyrica)
This surgery is often considered the most effective option for treating Trigeminal Neuralgia. It involves using general anesthesia, which causes the patient to temporarily lose consciousness or ‘go to sleep’. The surgeon makes a small cut behind the ear of the side of the face that has the pain. The surgeon then locates the trigeminal nerve through this cut. Once the trigeminal nerve is located, the surgeon can determine if there is a blood vessel pushing on the trigeminal nerve which might be causing the pain. In this case, the surgeon will put a small pad in between the blood vessel and the trigeminal nerve it is pushing on. This pad will cause the pain to go away because the blood vessel will be pushing into the pad instead of the trigeminal nerve and the nerve will no longer be worn down.
Microvascular decompression surgery lasts around 45 minutes and the patient typically stays in the hospital for 2 days after the surgery with additional recovery at home. This surgery has higher long-term success rates, rarely results in numbness, and has a low complication rate.
Radiofrequency lesion is a procedure is a minimally invasive treatment that involves temporarily anesthetizing the patient. The surgeon then inserts a needle through the cheek of the face, into the trigeminal ganglion. (A ganglion is a cluster of nerves.) Once the correct location is reached, the surgeon burns the painful nerve using electrical current to make it lose feeling and feel numb.
The nerve regrows in around half of the surgeries; therefore, repeat operations are common. This procedure is pain-free because the patient is put to sleep and it takes around 10 minutes. After this procedure, the patient goes to the recovery room for about 2 hours and then is free to go home. This procedure has the drawback of making the face numb (it feels like you’ve had a novocaine injection) unlike microvascular decompression. Radiofrequency lesion may be a good option for older or medically ill patients, where it would be a quicker and safer compared to other surgeries.
Radiosurgery is an outpatient procedure and involves focusing small beams of radiation on the trigeminal nerve. The radiation causes a change in the nerve from the energy of radiation that leads to pain relief. This option usually takes 6-8 weeks to for the pain to go away.
Other surgical treatments:
- Balloon Compression is a procedure that places a balloon to compress or flatten part of the trigeminal nerve to stop pain transmission.
- Glycerol Injection is a procedure that injects glycerol into the trigeminal ganglion to soothe the pain.