Trigeminal Neuralgia

Treatment

Mayo Clinic has comprehensive treatment options available. Dedicated neurologists and neurosurgeons have years of experience treating this condition.

Basically, three kinds of treatment are available:

• Medication
• Surgery
• Combination of medication and surgery

Medication

Medications used to treat trigeminal neuralgia include:

Anticonvulsant drugs
These are the most common medications used to treat trigeminal neuralgia. In the early stages of the disease, the medication controls pain for the majority of people. However, the medication's effectiveness may decrease over time. Side effects include dizziness, double vision, sleepiness and nausea.

Anticonvulsant drugs were originally developed to treat seizures but have also been very effective in treating trigeminal neuralgia even though trigeminal neuralgia is not connected to seizures.

Muscle relaxants
The effectiveness of muscle relaxants may increase when used in combination with anticonvulsant medications. Side effects include confusion, depression and severe drowsiness.

Trigeminal neuralgia often follows a "remitting and relapsing course" in which some patients experience pain, have their pain controlled with medication, and then, after weeks or months, are weaned off the medication and remain pain-free.

Surgery

While some who have trigeminal neuralgia receive adequate pain control with medications only, others eventually stop responding to their medications or they experience side effects. For those people, surgery — or a combination of surgery and medications — may be an option.

The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that is the source of the pain. Because the success of these procedures depends on damaging the nerve, one side effect is facial numbness of varying degrees.

These procedures include:

Alcohol injection
Alcohol injections under the skin around the branches of the trigeminal nerve may offer temporary relief by numbing the areas for days or months. Because the pain relief is not always permanent, repeated injections may be needed.

Glycerol injection
This procedure is called percutaneous glycerol rhizotomy (PGR); percutaneous means through the skin. A needle is inserted into the trigeminal nerve at the base of the skull where the trigeminal nerve root exits the skull. X-rays are taken to confirm that the needle is in the proper location. Once the location is confirmed, a small amount of sterile glycerol is injected. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals.

Initially, PGR relieves pain in most people. However, pain recurs in many people, and many experience mild facial numbness or tingling.

Balloon compression
In percutaneous balloon compression of the trigeminal nerve (PBCTN), a needle is inserted through the face and into the hole at the base of the skull where the trigeminal nerve exits. Then a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to compress the nerve, thereby blocking the pain signals.

PBCTN successfully controls pain in most people. Most people undergoing PBCTN experience facial numbness of varying degrees, and some patients experience weakness in the muscles used for chewing that is often temporary.

Electric current
Percutaneous stereotactic radiofrequency thermal rhizotomy (PSR) selectively destroys nerve fibers associated with pain. A needle is inserted through the face and into the opening in the skull for the trigeminal nerve. Once the needle is in place, an electrode is threaded through the needle until it rests against the nerve root.

The electrode's position is verified by electrically stimulating the trigeminal nerve. Then a current is passed through the tip of the electrode until it is heated to the desired temperature for about 70 seconds. This damages the nerve fibers and creates an area of injury (lesion). If the pain is not eliminated, additional lesions may be created.

PSR successfully controls pain in most people. A common side effect of this treatment is mild to severe facial numbness. As with the other percutaneous procedures, the pain may recur after months or years, and repeat procedures may be necessary.

Stereotactic radiosurgery
Stereotactic radiosurgery involves delivering single doses of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and eliminates the pain. Stereotactic radiosurgery is successful in eliminating pain more than half of the time. The procedure is painless and typically is done without anesthesia. It may take between three weeks and three months for pain relief to begin. Read more about stereotactic radiosurgery.

Microvascular decompression (MVD)
A procedure called microvascular decompression (MVD) involves relocating or removing blood vessels that have contact with the trigeminal nerve root where it leaves the brain stem. MVD does not damage or destroy part of the trigeminal nerve.

Microvascular decompression is a major surgical procedure done under general anesthesia in the operating room. Commonly, two to three days in the hospital are required after surgery. A small incision is made behind the ear. Then, through a small opening made in the skull, the trigeminal nerve is directly inspected with the aid of a microscope. If the surgeon sees an artery in contact with the nerve root, he or she directs it away from the nerve and places a small Teflon pad between the nerve and the artery to prevent contact with the nerve.

The majority of patients who have this procedure performed by a qualified neurosurgeon have no facial numbness and are pain-free, requiring no further medications. Usually, the pain relief is instant.

While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision and even a stroke or death.