Conventional Medical Treatments for Trigeminal Neuralgia

What is trigeminal neuralgia?

Trigeminal neuralgia is a neuropathic pain condition which develops when damage occurs to a trigeminal nerve. The trigeminal nerves are the main nerves on each side of the face — each side of the face contains one trigeminal nerve. They are responsible for carrying the sensations of pain and touch to the brain from areas of the face including, but not limited to, the mouth, nose and cheeks. When trigeminal neuralgia occurs, even a mild sensation (washing the face, eating a snack or a slight breeze touching the face, etc.) can cause intense pain. Individuals with trigeminal neuralgia often describe the pain as electric shock sensations. The condition is chronic, and the intensity and frequency of pain typically increase over time.

Types

Trigeminal neuralgia is classified into two types:

• Type 1 or “classic” type
  Type 1 presents as intense, brief, sudden, blazing facial pain lasting from a few seconds to several minutes. These episodes may occur in quick succession and are very painful.
• Type 2 or “atypical” type
  Type 2 presents as a persistent stinging, aching, burning soreness of relatively less intensity than type 1. An individual may experience both types of trigeminal neuralgia, sometimes simultaneously.

Treatment options

Conventional medical treatment options for trigeminal neuralgia include oral medications, injections and surgical procedures. They include the following:

Oral medications

Medications can be prescribed to reduce or block the pain signals that the brain receives.

• Anticonvulsant medicines work to block nerve firing. They are usually effective in treating trigeminal neuralgia type 1 but are less effective in treating trigeminal neuralgia type 2. Medications that may be prescribed include valproic acid, carbamazepine, gabapentin and oxcarbazepine.
• Antispasmodic agents, such as baclofen, can be used alone or with carbamazepine.

Injections

• OnabotulinumtoxinA injections help reduce trigeminal neuralgia pain. They are particularly recommended for those who are unaffected by oral medication.
• Glycerol injections block pain signals and destroy the trigeminal nerve.

Surgical procedures

If oral medication or injections do not help reduce the pain of trigeminal neuralgia, surgery may be recommended. Several surgical procedures are available. The purpose of surgery is to stop the compression of the trigeminal nerve. Which surgery is right for an individual is based on overall health, alignment of nerves involved and personal preference. Surgical treatments include the following:

• Microvascular decompression involves removing or relocating blood vessels in contact with the trigeminal nerve.
• Gamma knife radiosurgery utilizes radiation to destroy arteriovenous malformation in which a tangle of various arteries and veins is abnormally formed leading to compression of a trigeminal nerve.
• Rhizotomy is a common procedure for treating trigeminal neuralgia. During a rhizotomy, the nerve fibers that are responsible for facial numbness are destroyed.
• Balloon compression involves inserting a hollow needle (with a deflated balloon attached at the end) into the brain. A physician then inflates the balloon to destroy the trigeminal nerve which blocks pain signals from the area.
• Radiofrequency thermal lesioning involves destroying selected nerves that are linked to trigeminal neuralgia pain.