Trigeminal neuralgia treatment and options by Ray Sahelian, M.D.
September 12 2017

Trigeminal neuralgia is one of the most common causes of facial pain. It comes as short lasting episodes of unilateral electric shock-like pain with abrupt onset and termination, in the distribution of one or more divisions of the trigeminal nerve.

Trigeminal neuralgia is also known as tic douloureux. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary or mandibular area. At times, both distributions are affected.
   Typically, brief attacks are triggered by talking, chewing, teeth brushing, shaving, a light touch, or even a cool breeze. The pain may occur repeatedly throughout the day.

Diagnosis of trigeminal neuralgia
This is based on the history of symptoms. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic trigeminal neuralgia and suggest that pain may be secondary to a structural lesion.

Most cases are caused by vascular compression of the trigeminal root adjacent to the pons leading to focal demyelination and ephaptic axonal transmission. Brain imaging is required to exclude secondary causes.

Trigeminal neuralgia treatment
Treatment of classic trigeminal neuralgia for most patients is pharmacological therapy, while surgical approach is reserved for patients that are refractory to medical therapy and in cases of painful trigeminal neuropathy.

Patients with trigeminal neuralgia pain have three options: Medications, surgery, or a combination of the two.

Some of the prescription drugs used to treat trigeminal neuralgia include:
Anticonvulsant drugs may be effective initially but many patients cannot tolerate the side effects such as drowsiness, dizziness, double vision, and nausea. Some doctors prescribe muscle relaxants but they are not very effective and could lead to mental confusion and drowsiness to the point of being non-functional. The goal of surgery is to damage or destroy the part of the trigeminal nerve that is the source of the pain. A common surgical side effect is facial numbness.

Most patients respond well to pharmacotherapy; carbamazepine and oxcarbazepine are first line therapy, while lamotrigine and baclofen are considered second line treatments. Other drugs such as topiramate, levetiracetam, gabapentin, pregabalin, and botulinum toxin-A are alternative treatments. Surgical options are available if medications are no longer effective or tolerated. Microvascular decompression, gamma knife radiosurgery, and percutaneous rhizotomies are most promising surgical alternatives.

Acupuncture is worth trying if there is an experienced acupuncturist who is familiar with treating this condition.

J Maxillofac Oral Surg. 2013. Comparative Evaluation of Surgical Procedures for Trigeminal Neuralgia. TN is a debilitating ailment. Pharmacotherapy still remains the first line therapy for the management of TN. However, often the patients become refractory to the pharmacotherapy and need surgical interventions. There is a wide array of surgical treatment modalities available for TN and it is important to select the most appropriate surgery for a patient. This review evaluates the various surgical modalities by employing a comparative analysis with respect to patient selection, success rate, complications and cost effectiveness. For the evaluation, a critical review of literature was done with predefined search terms to obtain the details of individual procedures, which were then compared, under similar parameters. The results suggested that microvascular decompression seem to be the most effective treatment in terms of patient satisfaction and long term cost effectiveness. However, if patient factors do not permit, then the peripheral procedures may be employed as a substitute, though they have higher recurrence rate and complications and have relatively lower long term cost effectiveness. The newer modalities like stereotactic radiosurgery and botulinum injections have promising results and further refinement in these procedures will provide additional options for the patients suffering from TN.

Trigeminal neuralgia questions
Do you have anything natural that helps trigeminal neuralgia? Any herbs or supplements? The drugs the doctors give me keep me in a constant sleepy state.
   Not at this time. However, kava, hops tea, or valerian may be tried in the evening.