诊断
医疗护理专业人员主要根据您对疼痛的描述来诊断三叉神经痛，包括：
- 类型。与三叉神经痛有关的疼痛是骤然发生的，感觉犹如电击，且持续时间短暂。
- 部位。根据面部疼痛的部位，医疗护理专业人员可判断三叉神经是否受累。
- 诱因。进食、说话、轻触面部甚至微风吹拂都可能会诱发疼痛。
医疗护理专业人员可能会进行一些检查来诊断三叉神经痛。检查还能帮助寻找病因。这可能包括：
- 神经系统检查。触摸和检查各个面部部位有助于确定疼痛发生的确切部位。如果您疑似患有三叉神经痛，该检查可以帮助确定受累的是三叉神经的哪些分支。反射试验也可帮助医生确定您的症状是由神经压迫还是其他状况引起。
- 磁共振成像（MRI）。您可能需要接受 MRI，以找出三叉神经痛的潜在病因。MRI 可以发现多发性硬化症或肿瘤的迹象。有时可能在血管内注入造影剂，观察动脉和静脉中的血流情况。
您的面部疼痛可能是由多种不同状况引起，因此准确诊断至关重要。医疗护理专业人员还可能安排其他检查，以排除其他医疗状况。
治疗
三叉神经痛的治疗方法通常始于药物治疗，而有些人无需任何额外治疗。但随着时间的推移，有些人可能对药物治疗不再有反应，或者可能出现令人不舒服的副作用。这些人可以选择通过注射或手术方式来治疗三叉神经痛。
如果状况是由多发性硬化症等其他病因所致，您的医生会为您治疗这种基础病。
药物
为治疗三叉神经痛，医疗护理专业人员会给您开具药物以减少或阻断向大脑发送的疼痛信号。
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抗癫痫发作药物。医疗护理专业人员通常会开具卡马西平（Tegretol、Carbatrol 等）治疗三叉神经痛。该药已被证明能够有效治疗这种状况。
其他可使用的抗癫痫发作药物包括奥卡西平（Trileptal、Oxtellar XR）、拉莫三嗪（Lamictal）和苯妥英（Dilantin、Phenytek、Cerebyx）。其他可使用的药物包括托吡酯（Qudexy XR、Topamax 等）、普瑞巴林（Lyric）和加巴喷丁（Neurontin、Gralise、Horizant）。
如果您使用的抗癫痫发作药物的效果减弱，医疗护理专业人员可能给您增加剂量或换用其他类型的药物。抗癫痫发作药物的副作用包括头晕、意识模糊、困倦和恶心。此外，某些人群（主要是亚裔）服用卡马西平可能会引发严重反应。在开始使用卡马西平之前，可能会建议进行基因检测。
- 肌肉松弛剂。巴氯芬（Gablofen、Fleqsuvy 等）之类的肌肉放松药物可以单独使用，也可以与卡马西平联合使用。副作用可能包括意识模糊、恶心和嗜睡。
- Botox 注射。一些小型研究显示，对于无法再通过药物获得帮助的人群，A 型肉毒杆菌毒素（Botox）注射剂可缓解其因三叉神经痛所带来的疼痛。不过，仍需进行更多研究，方可将该疗法广泛用于这种状况。
Surgery
If medicines don't work, and your pain is caused by a blood vessel pressing on your trigeminal nerve, surgery may be recommended. The surgery for trigeminal neuralgia is called microvascular decompression (MVD). MVD is shown to be most effective for long-term pain relief, although it may come with serious risks.
During MVD, a surgeon moves or removes blood vessels that touch the trigeminal nerve to stop the pain from happening. A cut, known as an incision, is made behind the ear on the side where you feel the pain. Then the surgeon makes a small hole in your skull. This procedure is known as a craniotomy. Through this hole, the surgeon moves any arteries that are in contact with the trigeminal nerve. Finally, a soft cushion is placed between the nerve and the arteries.
If a vein is pressing on the nerve, the surgeon may remove it. Part of the trigeminal nerve may be cut if arteries aren't pressing on the nerve. This is known as a neurectomy.
Microvascular decompression can stop or reduce pain for many years. Long-term pain relief depends on the location of pain, type of pain and age of the person. Only a small number of people may have pain come back 3 to 5 years after surgery.
Risks of MVD include hearing loss, stroke, facial weakness, numbness or other complications. Most people who have this procedure have no facial numbness afterward.
Radiation
If MVD is not the right option for you, radiation treatment may help. Brain stereotactic radiosurgery, also known as Gamma Knife, is a noninvasive procedure to treat trigeminal neuralgia. Noninvasive means the procedure does not involve cutting into the body or making openings in the skin.
During Gamma Knife, a surgeon aims a focused dose of radiation at the root of the trigeminal nerve. The radiation damages the trigeminal nerve to reduce or stop pain. It may take up to a month after treatment before pain relief is felt.
Although pain relief may be slow to start, brain stereotactic radiosurgery is successful at stopping pain for most people. Like all procedures, there is a risk that pain may come back, often within 3 to 5 years. If pain returns, the procedure can be repeated or you may have a different procedure.
Common side effects of Gamma Knife include facial numbness. This may occur months or years after the procedure.
Rhizotomy
Rhizotomy might be recommended as another treatment if other options don't work or aren't possible. Rhizotomy is a minimally invasive procedure to treat trigeminal neuralgia. Minimally invasive means that only very small cuts are needed compared with regular surgery. These procedures often involve less pain and have faster recovery times.
In a rhizotomy, your surgeon destroys nerve fibers to reduce pain. This can cause some facial numbness. Types of rhizotomy include:
Glycerol injection. In this treatment, a needle goes through the face into an opening at the base of the skull. The needle is guided to a small sac of spinal fluid that surrounds the area where the trigeminal nerve divides into three branches. Then a small amount of sterile glycerol is injected. Glycerol is a clear, thick alcohol that damages the part of the trigeminal nerve that carries pain signals. This controlled injury blocks pain signals.
This procedure often relieves pain. However, pain returns in some people. Many people experience facial numbness or tingling after a glycerol injection.
Balloon compression. In this procedure, a hollow needle passes through the face. It is guided to a part of the trigeminal nerve that goes through the base of the skull. Then a thin, flexible tube called a catheter with a balloon on the end is threaded through the needle. The balloon inflates with enough pressure to damage the trigeminal nerve and block pain signals.
Balloon compression successfully controls pain in most people, at least for a period of time. Most people who have this procedure have some facial numbness for a brief time.
Radiofrequency thermal lesioning. This procedure destroys certain nerve fibers known to cause pain. While you're sedated, your surgeon inserts a hollow needle through your face. The needle is guided to a part of the trigeminal nerve that goes through the base of the skull.
Once the needle is in place, your surgeon briefly wakes you from sedation. An electrode is passed through the needle, which sends a mild electrical current through its tip. Your surgeon will ask you to say when and where you feel tingling.
When your surgeon finds the part of the nerve causing your pain, you're returned to sedation. Then, the electrode is heated until it damages the nerve fibers. This creates an area of injury known as a lesion. If the lesion doesn't stop your pain, your surgeon may create more lesions.
替代医学
三叉神经痛的替代治疗方法尚未像药物或外科类手术那样得到充分的研究。支持使用这些替代治疗方法的证据很少。
但是，有些人发现针刺疗法、生物反馈、脊柱推拿疗法、维生素或营养疗法等治疗方法可以缓解三叉神经痛。在尝试替代治疗方法之前，请务必先咨询医生，因其可能与您的其他治疗方法相互影响。
妥善处理与支持
患上三叉神经痛可能给生活带来困难。这种疾病可能会影响您与亲朋好友的互动、您的工作效率以及您的整体生活质量。
您可能会在互助组中获得鼓励和理解。小组成员通常了解最新的治疗方法，并且往往会分享自己的经验。如果您有兴趣，医生可能会给您推荐当地的互助组。
准备您的预约
如果您有三叉神经痛的症状，请与您的医疗护理专业人员约诊。初次就诊之后，您可能会前往受过脑和神经系统状况方面专门培训的医生（称为神经内科医生）处就诊。
您可以做的准备
- 写下您出现的所有症状及持续时间。
- 记录任何引起面部疼痛的诱因。
- 列出您的关键医疗信息，包括您正在接受治疗的任何其他医疗状况。同时列出您正在使用的任何药物、维生素或补充剂的名称。
- 尽可能让家人或朋友陪同就医。陪同者可能会记住您遗漏或忘记的一些事项。
- 提前写下您的问题。这有助于您充分利用向医疗护理专业人员咨询的时间。
对于可能存在的三叉神经痛，要咨询的一些基本问题包括：
- 我的疼痛最有可能是什么原因造成的？
- 我需要做什么诊断检测吗？
- 您推荐哪种治疗方案？
- 如果您建议用药，可能存在哪些副作用？
- 我的余生都要一直接受治疗吗？
- 您预计我的症状在治疗后会有多大程度的改善？
- 适合进行外科手术吗？
除了您提前准备好的问题外，就诊期间，您还可以随时提问您想到的其他问题。如果有不明白的方面，也可以提问。
医生可能做些什么
您可能会被问到以下问题。请做好回答这些问题的准备，这样可以腾出更多时间，以详细了解您想要深入讨论的话题。医疗护理专业人员可能会询问：
- 您有哪些症状以及症状出现在哪里？
- 您最开始出现这些症状是什么时候？
- 您的症状有没有逐渐加重？
- 您多久出现一次面部疼痛？您是否注意到有什么因素似乎会触发面部疼痛？
- 面部疼痛通常持续多久？
- 这些症状对您生活质量的影响有多严重？
- 您是否接受过牙科手术或面部及周围的手术，比如鼻窦手术？
- 您是否经历过面部创伤，比如因损伤或意外导致脸部受伤？
- 截至目前，您是否尝试过对面部疼痛进行任何治疗？是否有任何治疗方法有效？
- 您治疗期间出现过哪些副作用？