Trigeminal neuralgia pain is some of the worst pain that a person can ever experience. Excruciating, long-lasting, and often completely debilitating, effective treatment has been challenging to find. Since most patients respond best to a wide variety of trigeminal neuralgia treatments offered concurrently, here are 16 trigeminal neuralgia treatment options that may work for you.
What is trigeminal neuralgia?
Trigeminal neuralgia is debilitating nerve pain that is commonly felt in the face and head. It occurs along the trigeminal nerve, which enervates major portions of the face.
An estimated four out of 100,000 people in the U.S. (typically more women ages 18 to 44 than men) suffer from this condition. The trigeminal nerve branches out just in front of both ears on the side of the face and into the following areas:
- Ophthalmic: Enervates the forehead and across the eyes
- Maxillary: Responsible for sensation along the cheeks and under the eyes
- Mandibular: Causes sensation in the jaw, mouth, and lips
Trigeminal neuralgia causes
This type of pain can be triggered by the slightest breeze or touch to the face. Other triggers include eating, talking, smiling, and taking a shower with water on the face.
Primary causes of trigeminal neuralgia seem to be any trauma or injury to the trigeminal nerve but may also include:
- Multiple sclerosis
- Herpes zoster (shingles)
Trigeminal neuralgia symptoms
Symptoms of trigeminal neuralgia can include:
- Pain in the cheek, jaw, teeth, gums, or lips (less frequently the eyes and forehead)
- Severe pain that feels like an electric shock
- Pain triggered by light touch or movement
- Intermittent pain punctuated by periods of relief
- Burning or aching that turns into sharp pain
- Pain on just one side of the face
- Pain that occurs more often and more intensely over time
Trigeminal neuralgia is sometimes misdiagnosed as migraine. While migraine pain can last for hours and is typically experienced behind the eyes, trigeminal neuralgia symptoms are experienced in shorter bursts, largely centered on the face.
Proper diagnosis is crucial to the treatment of trigeminal neuralgia, as treatments for other pain syndromes are usually unsuccessful.
What are trigeminal neuralgia treatment guidelines?
Trigeminal neuralgia treatment begins with a proper diagnosis, made with a complete medical history that includes:
- Description of the pain’s location
- Pain triggers, length of the attack, and potential triggers
- List of unsuccessful medications and treatments for pain
- Presence of herpetic vesicles
A magnetic resonance imaging (MRI) is also completed to examine the soft tissues and rule out a tumor pressing into the trigeminal nerve. Once a proper diagnosis is made, treatment can begin.
At home treatments for trigeminal neuralgia
While at home treatments for trigeminal neuralgia are not likely to be completely pain-relieving on their own, you can take important steps to minimize attacks and help lessen their duration. Before and after diagnosis, keep a pain journal to record your attacks, including potential triggers and the duration and intensity of attacks.
In a seemingly contradictory way, many of the same patients whose pain is triggered by a light touch find relief with firm pressure applied intermittently to the affected area. Similarly, some patients find relief by apply hot or cold packs to the painful area of the face. This can be done with an ice pack or a warm washcloth. Some patients combine pressure and heat by applying a heated bean bag to the affected area.
While some triggers are nearly impossible to avoid, knowing the ones you can eliminate can help. Record all episodes and potential triggers (including food) and eliminate or minimize the triggers you can.
Complementary therapies for trigeminal neuralgia
As stated above, the best treatment approach to trigeminal neuralgia is a comprehensive one that generally includes complementary therapies. While there is very limited research on the efficacy of pain relief methods for trigeminal neuralgia, complementary therapies can provide supportive relaxation and psychological benefits to enhance other treatments.
In 2017, one study published in the Chinese Journal of Integrative Medicine found that patients with trigeminal neuralgia experienced more pain relief when they combined acupuncture with certain medications. Even though the study was small, the results are promising, as acupuncture is readily accessible and has very rare side effects.
Other complementary therapies can include:
- Mediation practice
- Float tanks
These therapies give patients the opportunity to care for themselves in a deep and meaningful way in conjunction with their other treatments.
Trigeminal neuralgia medications
Trigeminal neuralgia treatment guidelines with medication are much different from other pain condition guidelines. Because trigeminal neuralgia does not respond to anti-inflammatory medications (prescribed or over the counter) or opioids, your doctor will approach treatment with medication from a different angle.
Anticonvulsants are a first-line treatment option for trigeminal neuralgia. Common anticonvulsants include:
- Carbamazepine (e.g., Tegretol and Carbatrol)
- Oxcarbazepine (Trileptal)
- Lamotrigine (Lamictal)
- Phenytoin (Dilantin, Phenytek)
Anti-anxiety drugs such as clonazepam (Klonopin) and gabapentin (e.g., Neurontin and Gralise) may also be treatment options.
There can be serious side effects for anticonvulsant drugs, especially if they begin to lose effectiveness and are prescribed in higher doses. Side effects include dizziness, confusion, drowsiness, and nausea. For some patients, specifically of Asian descent, carbamazepine can cause a serious drug reaction. It is important to evaluate your tolerance for side effects before beginning anticonvulsant medications.
Even though pain is caused by issues in the trigeminal nerve, antispasmodic agents can work to counteract the effects of this nerve inflammation. Muscle relaxers can help ease tension in the musculature of the face and head. The most common antispasmodic medication used is baclofen (e.g., Gablofen and Lioresal), often in combination with carbamazepine. In addition to potential side effects of carbamazepine, muscle relaxants can also cause confusion, nausea, and drowsiness.
In some patients, the tricyclic antidepressant amitriptyline may help. There are plentiful adverse side effects, though, so few patients choose this therapy.
Botox injections for trigeminal neuralgia
OnabotulinumtoxinA (Botox) injections are typically used to relieve migraine pain, but small studies suggest that it may also help relieve the pain of trigeminal neuralgia.
The treatment is generally well-tolerated and most patients were completely relieved of pain and without reoccurrence for at least six months. This treatment has few adverse side effects and can be useful for people who are no longer finding relief with medications (but who would like to delay more interventional treatment options).
The one downside of this treatment approach comes to cost. Because it is a newer treatment, some insurance providers don’t cover the cost of these injections. You’ll want to talk to your doctor about how much they charge, any payment plan options, or other ways you can manage the cost of these injections. Thankfully, many patients only need to receive these a few times a year.
Interventional approaches for trigeminal neuralgia
If you are experiencing recalcitrant trigeminal neuralgia pain that is unresponsive to your best efforts at home and through medications, it may be time to consider more interventional treatments.
There are two types of interventional treatment options for trigeminal neuralgia:
- Surgical procedures
Percutaneous trigeminal radiofrequency rhizotomy destroys the pain-causing areas of the nerve that is causing your pain while leaving the touch-sensitive fibers intact.
If patients are not good candidates for surgery, this is the technique of choice. Side effects can include weakness, numbness, and changes in tear and saliva production. There are three main types of rhizotomy:
- Radiofrequency ablation (also referred to as radiofrequency thermal lesioning)
- Glycerol injections
- Balloon compression.
Radiofrequency ablation is a less-invasive trigeminal neuralgia treatment option. By inserting a thin probe through the nose or mouth, your doctor will be able to target certain nerves and discharge an electro-thermal impulse. This can selectively eliminate the nerve tissue that is responsible for your pain signals.
In a glycerol injection, glycerol is injected near the trigeminal nerve where it branches. Because the location cannot be precisely controlled, the results are not as certain, and more than half of the 80% of patients who experience relief see a return of their pain within five years. Most patients also experience lingering numbness in the injection area.
Balloon compression is a new rhizotomy treatment based on older trigeminal neuralgia treatment options that partially injure the trigeminal nerve. A small balloon is inserted near the trigeminal nerve and then inflated to compress (and thus damage) the trigeminal nerve. The pain signals are blocked by the damage.
Surgical procedures most often focus on interrupting, or damaging, the part of the nerve that sends pain signals to the brain. This damage may be permanent, or it may provide temporary relief and need to be periodically repeated.
One surgical technique is microvascular decompression of the trigeminal nerve. This microsurgery procedure moves blood vessels that are compressing the trigeminal nerve, offering long-term pain relief.
This may be a good choice for patients under 65 with no comorbid conditions or other surgical risk factors. Still, as with any surgery, there is the potential for sometimes serious side effects exists, including meningitis, major neurological issues, loss of sensation, and cranial nerve palsy. In exceedingly rare cases, postoperative bleeding and death can occur. For many who have suffered, the complete relief experienced by between 75 and 80% of patients is worth the risk of side effects.
Stereotactic radiosurgery, commonly referred to as gamma knife, directs a small amount of radiation to the root of the trigeminal nerve. Pain relief using this method occurs gradually and is usually complete within a month. Most patients (90 to 95%) find success with this surgical intervention, but if not, the treatment can be repeated.
New treatments for trigeminal neuralgia
Trigeminal neuralgia has been such an evasive pain condition that new research on experimental treatments is hard to find.
Since finding a link between trigeminal neuralgia and multiple sclerosis, one study conducted by the Center of Dental Medicine at the University of Zurich in Switzerland has been looking at a new sodium channel blocker referred to as BIIB074. Sodium channels are responsible for pain and its intensity, and this experimental treatment, now in the second phase, is looking to selectively block this channel only when needed.
This differs from current treatments that continuously block sodium channels, causing unwanted side effects. Results are preliminary and the study is small, but researchers are still committed to helping patients find relief.
Dominik Ettlin, one of the study’s authors, had this to say about the drug’s potential:
“Unlike conventional drugs, which often cause tiredness and concentration problems, BIIB074 was not only effective, but also very well tolerated. We will now test the new substance in a lot more subjects during the next study phase, which will reveal whether the new hope for more effective pain relief is justified.”
If you are looking for trigeminal neuralgia treatments that can provide relief, it may be time to talk to a pain specialist. You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.