Trigeminal neuralgia is a chronic condition that usually worsens over time and cannot be cured. Medication can ease symptoms to a certain extent and surgery may be considered in cases where pain cannot be relieved with medication. The severe and intense pain that is typical of trigeminal neuralgia may be brought on by simple day-to-day activities such as talking, smiling, swallowing, shaving or brushing the teeth. The condition can therefore have a severe impact on a patient’s quality of life.
Regular pain relievers such as paracetamol are not effective at reducing the pain caused by trigeminal neuralgia.
The first type of medication usually prescribed is an anticonvulsant. These drugs slow the transmission of electrical pain impulses along the trigeminal nerve.
Carbamazepine is usually the first drug prescribed and is taken one or two times a day. If carbamazepine is ineffective, another drug called gabapentin may be prescribed. In cases that do not respond effectively to either drug, other medications such as oxcarbazepine and phenytoin may be advised.
Surgery and other treatments
Surgery and other procedures may be used to treat some individuals with trigeminal neuralgia and examples include:
Glycerol injection – Glycerol injected into the central part of the trigeminal nerve can provide pain relief for 6 to 12 months.
Peripheral radiofrequency thermocoagulation – This procedure entails damaging the nerve endings just enough to dull their ability to transmit pain impulses. However, the procedure is associated with a risk of severe and constant pain that cannot be cured.
Electric current therapy – Short bouts of electric current are used to numb the trigeminal nerve and reduce pain.
Balloon compression – A tiny balloon inflated around the trigeminal nerve relieves the pressure exerted on it.
Micovascular decompression surgery – This procedure involves removing or repositioning blood vessels that are compressing the trigeminal nerve.
Stereotactic radiosurgery – This is a relatively new procedure where radiation beams are focussed on the trigeminal nerve to slow the pain impulses transmitted.
Reviewed by Sally Robertson, BSc