Trigeminal neuralgia, a rare nerve pain disorder, can be difficult to manage. Each case presents differently, with pain severity and location varying from patient to patient. As you begin your journey with trigeminal neuralgia treatments, keep in mind that you and your neurologist and possibly your neurosurgeon will create a custom-tailored solution for your individual needs.
Medical Trigeminal Neuralgia Treatments
The first course of treatment in all instances of trigeminal neuralgia is through the use of prescription medication. Before you were correctly diagnosed with trigeminal neuralgia, you may have received opioid – also called narcotic – pain medications in an emergency room or urgent care setting. While you may notice temporary relief through these kinds of medications, they aren’t a good choice for a long-term solution. Opioid medications can be extremely addictive, and you may build a tolerance for them over time, limiting their effectiveness.
The best options for medicinal trigeminal neuralgia treatments include anti-spasmodic medications like Tegretol (generic: carbamazepine) or Trileptal (generic: oxcarbazepine). These medications are typically used for seizure disorders like epilepsy, but they’ve proven to be highly effective for trigeminal neuralgia sufferers as well. It may take several dosage changes to reach the optimal level of pain management through these anticonvulsant drugs. Depending on how your trigeminal neuralgia reacts, additional medications like Neurontin (generic: gabapentin) or Lyrica (pregabalin).
In addition to medicine, you can work to improve your trigeminal neuralgia by avoiding triggers. Triggers that can cause or worsen trigeminal neuralgia pain include cool breezes, cold foods or metal silverware touching your teeth, overly hot or spicy meals or foods that are hard to chew. Experiment to see what changes you can make to lessen your pain. Also, speak with your physician about whether you may be suffering from migraine headaches as well – trigeminal neuralgia flares and migraines can interact with each other to drive pain levels higher.
Surgical Trigeminal Neuralgia Treatments
Once you have exhausted all options for treating your trigeminal neuralgia medicinally, your neurologist may refer you to a neurosurgeon to pursue surgical options. Surgery may become your next course of action for two reasons: first, medication fails to effectively control your pain, or second, the side effects you experience may outweigh the relief provided by the medication. Side effects may include extreme fatigue, brain fog, dizziness and drowsiness. Carefully monitor your own symptoms and side effects to discuss with your doctor.
Once you’re to the point of discussing surgery, you and your neurosurgeon will likely first consider microvascular decompression. This is the first line choice for patients who are physically healthy overall and whose radiological scans show a clear impingement upon the trigeminal nerve by a nearby blood vessel or other facial structure.
Microvascular decompression is an invasive procedure but offers a very high success rate for patients, 80 percent or higher, because patients are so carefully screened before being approved for this procedure. During microvascular decompression, your neurosurgeon carefully enters the back of your head through a small hole in your skull and then uses imaging to locate the impingement so that a surgical sponge can be placed between the nerve and offending vessel. This effectively ends the painful signals previously being sent down the trigeminal nerve.
For patients whose overall health might prohibit microvascular decompression, the next treatment option to be considered is Gamma Knife Radiosurgery. During this procedure, your neurosurgeon will work with a team of radiation specialists to determine the area of your trigeminal nerve that is broadcasting pain. During the procedure, you will be placed in a head frame and several beams of radiation will carefully target the designated portion of your nerve.
After the procedure, as the radiation continues to work, you will begin to experience pain relief.
Another surgical technique you and your neurosurgeon may consider is percutaneous rhizotomy. This is another highly targeted procedure, which is aimed at disruption only of the portion of your trigeminal nerve causing pain. During percutaneous rhizotomy, a thin needle will be threaded into your cheek. Then, your pain levels will be tested to determine the precise location of transmission. Once located, a small charge of heat will go through the needle and singe the misfiring area of your nerve. Like other procedures, you’ll notice gradual, not instantaneous, relief.
Finally, for cases of trigeminal neuralgia that have not responded to any other procedure, your neurosurgeon may recommend the implantation of a pain stimulator. This small device is placed just beneath your skin at the base of your skull on whichever side your trigeminal neuralgia is occurring. The device is then hooked up to a control that sends alternative signals down your nerve channel and effectively confuses the nerve from continuing to signal pain. Typically, this implant is made temporarily at first, to gauge how your trigeminal neuralgia reacts. If successful, a more permanent implant can be embedded.
While trigeminal neuralgia is hard to diagnose and harder still to treat, you can work with your capable team of doctors to explore and implement a wide variety of medical and surgical trigeminal neuralgia treatments until you find the option that is your own very best solution.
