Trigeminal Neuralgia Treatment Options - Michael Lim, MD, Chair of Neurosurgery at Stanford Medicine (2024)

FAQs

Trigeminal Neuralgia Treatment Options - Michael Lim, MD, Chair of Neurosurgery at Stanford Medicine? ›

After diagnosing trigeminal neuralgia, magnetic resonance imaging should be performed to rule out multiple sclerosis, a tumor process that can secondarily cause trigeminal neuralgia. The drug of choice for treating trigeminal neuralgia is still carbamazepine.

After diagnosing trigeminal neuralgia, magnetic resonance imaging should be performed to rule out multiple sclerosis, a tumor process that can secondarily cause trigeminal neuralgia. The drug of choice for treating trigeminal neuralgia is still carbamazepine.

Stereotactic radiosurgery is a fairly new treatment that uses a concentrated beam of radiation to deliberately damage the trigeminal nerve where it enters the brainstem.

Mayo Clinic doctors trained in brain and nervous system conditions (neurologists), brain and nervous system surgery (neurosurgeons), and doctors trained in treating children who have brain and nervous system conditions (pediatric neurologists) diagnose and treat people who have trigeminal neuralgia.

Carbamazepine and oxcarbazepine are drugs of first choice. Lamotrigine, gabapentin, pregabalin, botulinum toxin type A and baclofen can be used either alone or as add-on therapy. Surgery should be considered if the pain is poorly controlled or the medical treatments are poorly tolerated.

Brain stereotactic radiosurgery, also known as Gamma Knife.

The radiation damages the trigeminal nerve to reduce or stop pain. Pain relief occurs gradually and may take up to a month. Brain stereotactic radiosurgery is successful in stopping pain for most people.

The anti-convulsant drug most commonly prescribed for trigeminal neuralgia is carbamazepine (Tegretol), which can provide at least partial pain relief for up to 80 to 90 percent of patients.

Pain episodes may be triggered by anything touching the face or teeth, including shaving, applying makeup, brushing teeth, touching a tooth or a lip with the tongue, eating, drinking or talking — or even a light breeze or water hitting the face.

When in pain, warm or cool compresses may help. Some people find relief from a cool compress, but this can trigger an attack if you are sensitive to cold. Applying a warm compress or heated bean bag is soothing to some people.

What can a neurosurgeon do for trigeminal neuralgia? ›

Microvascular Decompression for Trigeminal Neuralgia

In most cases, there is a blood vessel (typically an artery, but sometimes a vein) compressing the trigeminal nerve. By moving this blood vessel away from the nerve and interposing a padding made of Teflon felt, the pain is nearly always relieved.

For years, it has been an accepted practice to confirm the debilitating facial pain condition known as trigeminal neuralgia (TN) using magnetic resonance imaging (MRI) to see if the trigeminal nerve is being compressed by neighboring blood vessels or other structures and to offer brain surgery as a result.

The Food and Drug Administration (FDA) has granted Fast Track designation for basimglurant (NOE-101; Noema Pharma, Basel, Switzerland) to treat individuals with trigeminal neuralgia (TN).

A minimally invasive technique, gamma knife radiosurgery allows doctors to direct radiation at a small target inside the head. In conjunction with MRI or other high-resolution computer imaging, the surgeon directs highly focused beams of radiation at the site where the trigeminal nerve exits the brain stem.

Relieving Trigeminal Neuralgia Pain at Home

Avoid your triggers. This can help minimize the pain you experience. Common triggers include hot or cold foods and drinks, spicy foods and air blowing across the face. Some people find that drinking through a straw helps keep the hot or cold liquid from stimulating pain.

Red flags such as progressive CN VII palsy or persistent CN V paraesthesia, numbness, formication or pain, particularly in the presence of immuno-compromise and/or a history of facial actinopathy should raise suspicion for PNS.