Treatment for Trigeminal Neuralgia
Symptoms of trigeminal neuralgia (tic douloureux) often come and go over time. Treatment for the condition varies and may include medication, complementary therapies, surgery, and a combination of these methods. In many cases, patients are treated with medications for a period of weeks or months and then the drugs are discontinued.
Medication to Treat Trigeminal Neuralgia
Anticonvulsant drugs (e.g., carbamazepine [Tegretol], [Carbatrol]) often are used to treat trigeminal neuralgia. These drugs, which are also used to treat epilepsy, are effective in about 50–75 percent of cases.
Side effects include drowsiness, fatigue, nausea, dizziness, headache, and constipation. Carbamazepine also can cause a decrease in blood cell production, which can be serious. Patients who experience rash, sore throat, mouth sores, fever, or unusual bleeding or bruising while taking this medication should notify a health care provider immediately.
In some cases, other types of medication (e.g., muscle relaxants [Baclofen]) are used in combination with anticonvulsants to treat trigeminal neuralgia. Side effects of these medications include nausea, drowsiness, dizziness, and mental confusion.
Complementary Therapies to Treat Trigeminal Neuralgia
Trigeminal neuralgia sometimes can be managed using complementary treatments, including the following:
- Acupuncture is a technique used in Traditional Chinese Medicine (TCM) that involves inserting fine needles into specific points in the body to reduce pain or improve function.
- Biofeedback uses a monitoring device to measure pulse, brain waves, and blood pressure. When changes occur in these involuntary responses, a tone is emitted and the patient is instructed in methods that can help control pain.
- Transcutaneous electric nerve stimulation (TENS) is a procedure that involves using mild electric currents to stimulate certain nerve endings that, when stimulated, block pain transmissions.
Surgery to Treat Trigeminal Neuralgia
Trigeminal neuralgia that does not respond to medication may be treated surgically. There are a number of procedures available to treat this condition. In many cases, the goal of surgery is to destroy the portion of the trigeminal nerve that is causing the pain. Side effects of these procedures often include facial numbness and tingling.
Types of surgery used to treat tic douloureux include the following:
- Alcohol injections
- Balloon compression
- Glycerol injections (also called percutaneous glycerol rhizotomy [PGR])
- Radiofrequency thermal rhizotomy
- Stereotactic radiosurgery
- Microvascular decompression
Alcohol injections may provide temporary relief for trigeminal neuralgia. In this procedure, alcohol is injected in the area surrounding the branches of the trigeminal nerve. Pain relief usually lasts days to months and the treatment often must be repeated.
Balloon compression of the trigeminal nerve involves inserting a hollow needle into the base of the skull where the trigeminal nerve is located and threading a thin tube (catheter) with a balloon on the end through the needle. Once the balloon is in place, it is inflated to compress the nerve and block pain signals. This procedure may cause numbness and weakness in the muscles used for chewing.
Glycerol injection (percutaneous glycerol rhizotomy [PGR]) involves injecting a small amount of a sterile solution (glycerol) under the skin (i.e., percutaneous) and into the area surrounding the trigeminal nerve to destroy the portion of the nerve that is causing symptoms.
In this procedure, a needle is inserted into the area surrounding the nerve and x-rays are used to make sure the needle is in the correct position. This treatment usually provides relief in 3–4 hours, but the results are not permanent and glycerol injections become less effective over time.
In radiofrequency thermal rhizotomy, nerve fibers that are associated with pain are destroyed. A needle is inserted into the base of the skull to the trigeminal nerve and an electrode is threaded through the needle to the nerve root. Electric current is then applied to heat the nerve root to the desired temperature (usually for about 1 minute) to damage the nerve fibers and eliminate pain.
This procedure has a high success rate. Side effects include facial numbness, which can range from mild to severe. Results can be temporary and additional treatment may be necessary.
Stereotactic radiosurgery involves using a single dose of radiation to damage the trigeminal nerve root and eliminate pain. Radiosurgery can effectively treat tic douloureux in about 50% of cases; however, pain relief may take up to 3 months. This procedure does not require anesthesia.
Microvascular decompression is major surgery. This procedure is performed under general anesthesia and usually requires hospitalization for 3 or 4 days. In microvascular decompression, a small incision is made behind the ear and the surgeon creates a small hole in the skull to see the trigeminal nerve and determine if it is being compressed by a blood vessel (i.e., vein, artery). Once the blood vessel is located, a small pad is inserted to prevent it from pressing on the nerve.
This procedure has a high rate of success. Risks include hearing damage, facial weakness, numbness, and double vision. In rare cases, stroke and death can occur.
Trigeminal Neuralgia Prognosis
Trigeminal neuralgia is not life-threatening, but the effects can be long-lasting and the condition often can be disabling. In severe cases, patients may be unable to participate in daily activities. Patients who have tic douloureux may benefit from seeing a pain management specialist.