Medication is usually the first line of treatment recommended for trigeminal neuralgia. Drugs that are commonly prescribed include anticonvulsants and antibacterial medications. Anticonvulsants work by stabilizing the hyperexcitable trigeminal nerve and reducing nerve impulses. Commonly used anticonvulsants include carbamazepine, oxcarbazepine, gabapentin and pregabalin. These medications must be carefully titrated under medical supervision as side effects such as dizziness are common initially. Anticonvulsants prove effective for symptom relief in around 70% of trigeminal neuralgia cases.
Antibacterial medications may also provide some relief as there is evidence that trigeminal neuralgia could be caused due to an underlying viral infection near Trigeminal Neuralgia Treatment nerve root. Medications prescribed include baclofen, lamotrigine and phenytoin. While these medications are generally first line treatments, not everyone experiences complete relief of symptoms. Moreover, medications need to be taken on a long term basis and side effects with chronic use are another limitation.
Surgery
When medications do not adequately control pain or cause intolerable side effects, surgical options are considered. The most common surgeries for trigeminal neuralgia treatment include rhizotomy, balloon compression and glycerol rhizotomy.
Rhizotomy involves cutting or destroying a portion of the trigeminal nerve near the brainstem to block pain signals. This can be done using microvascular decompression, radiofrequency thermocoagulation or glycerol injection. Microvascular decompression surgery aims to physically remove any blood vessels compressing the trigeminal nerve root. It has long term success rates of over 90% but requires general anesthesia and carries risks inherent to brain surgeries like bleeding and infection.
Balloon compression involves threading a balloon catheter into the trigeminal nerve region and inflating it to compress and potentially damage the nerve fibers transmitting pain signals. It has moderate risks and provides relief in 60-70% cases over 2-5 years. Glycerol rhizotomy involves injecting glycerol near the trigeminal nerve root to dehydrate and damage nerve fibers. It has fewer side effects than other surgeries but the pain relief is not permanent requiring repeat injections.
Stereotactic radiosurgery delivers high doses of radiation to the trigeminal nerve region and is a non-invasive option. It has shown good long term outcomes in around 80% cases however the effects are gradual over months requiring medications in the interim period. Selection of surgical option depends on factors like severity, duration of symptoms, medial fitness and risks involved.
Lifestyle Changes
Certain lifestyle modifications may help provide symptomatic relief when combined with medications or used as an adjunct. Avoiding triggers is important. Common triggers that exacerbate pain include cold wind, chewing or talking. Wearing scarves or masks outdoors in winter can help. Applying warm or cold compresses may temporarily relieve pain from flare ups. Relaxation techniques like yoga, meditation and deep breathing help reduce stress which is a known trigger for many patients. Maintaining good oral hygiene and dental health also prevents dental issues from exacerbating facial pain. Leading a generally healthy lifestyle with a balanced diet and adequate sleep promotes overall healing and wellbeing.
Alternative Therapies
Some alternative and complementary therapies found to be moderately helpful for trigeminal neuralgia include acupuncture, Botox injections, cognitive behavioral therapy and transcutaneous electrical nerve stimulation (TENS).
Acupuncture aims to relieve pain by stimulating specific points along the meridian lines in the face using thin needles. It seems to work by activating the release of endorphins which are the body’s natural painkillers. Botox injections delivered near sites of severe pain may provide temporary relief by blocking pain signals. Their effects last 2-6 months on average.
Cognitive behavioral therapy helps patients learn how to change thought patterns that contribute to increased pain perception through techniques like relaxation, distraction and positive self-talk. TENS units deliver electric pulses to override pain signals via electrodes taped to the face. These therapies may be effective when used along with conventional treatment rather than as replacements. However, more research is still needed to establish their long term efficacy.
While there is currently no cure for trigeminal neuralgia treatment options exist that provide adequate relief of symptoms for most patients when individually tailored. A multidisciplinary approach combining medications, lifestyle modifications and potentially minimally invasive procedures offers the best approach. Patient education and support are also important to help manage this chronic painful condition. Further research continues into newer drugs and treatments to enhance outcomes.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it.
