treatment
Last edited 07/2019 and last reviewed 04/2021
The aim of treatment for trigeminal neuralgia is pain relief
- medical management
- carbamazepine
- only drug licensed for trigeminal neuralgia in the UK
- 70% of patients with trigeminal neuralgia have good initial pain control with carbamazepine (1)
- side effects include: tiredness and poor concentration and there is a high risk of drug interactions.
- oxcarbazepine
- a keto derivative of carbamazepine
- recommended as second line medicine
- has shown similar efficacy to carbamazepine
- baclofen
- useful in multiple sclerosis and when combined with carbamazepine
- lamotrigine
- can be used with carbamazepine or oxcarbazepine (1)
- surgical management
- patients with poor control of pain while taking medications, may need surgical intervention.
- surgical treatment falls in to two categories
- palliative destructive procedures
- involve partly controlled destruction of trigeminal nerve root with the aim to relieve pain
- heat (radiofrequency lesioning), chemicals (with a viscous glycerol called glycerol rhizolysis), and mechanical (by crushing the nerve against surrounding bone and dural reflections called balloon compression) procedures are used
- can be performed for all causes of trigeminal neuralgia
- microvascular decompression:
- aims to decompress the trigeminal nerve, and deals with the cause of trigeminal neuralgia in the 95% of cases not caused by other lesional causes (1)
In patients who present with severe unremitting pain, opiods will not control the symptoms. A lidocaine injected into the trigger point is much more effective in these patients (1).
NICE state (2):
- offer carbamazepine as initial treatment for trigeminal neuralgia
- if initial treatment with carbamazepine is not effective, is not tolerated or is contraindicated, consider seeking expert advice from a specialist and consider early referral to a specialist pain service or a condition-specific service
Reference: