Are there any over-the-counter drugs available for treatment?
The drugs that effectively combat the pain of trigeminal neuralgia are antiepileptic drugs, which are available only on prescription and are not available in pharmacies without a prescription. One can also try to reduce the pain with over-the-counter homeopathic remedies, such as Arsenicum album. However, the effectiveness of homeopathy is highly doubted when it comes to the severity of pain attacks.
What are the side effects of the drugs?
The drugs used for the treatment of trigeminal neuralgia belong to the group of antiepileptic drugs, which are used for other diseases besides epilepsy. These drugs often cause dizziness and double vision, affect the gastrointestinal tract in the form of abdominal pain and nausea, and can attack the liver and kidney if used over a long period of time. Carbamazepine should also not be taken during the first trimester of pregnancy.Furthermore, antiepileptic drugs alter certain values in the blood and lead to a decrease in sodium and white blood cells.
Surgical treatment of trigeminal neuralgia
Surgical treatment of trigeminal neuralgia is considered in case of non-response of the medication or intolerable side effects. Drug therapy is considered ineffective if there is no improvement after 3 months. There are various procedures available for the surgical treatment of trigeminal neuralgia.
A distinction is made between methods without opening the skull bone and methods that require opening the skull bone. The former include methods that perform mechanical, thermal or electrical sclerotherapy at a nerve switch point, so-called transcutaneous stimulation-controlled thermocoagulation surgery methods. In more than 90% of the cases, painlessness is thus achieved, and the long-term results are also relatively good.
However, side effects in the form of sensory disturbances and occasionally painful sensations in the area supplied by the trigeminal nerve must be expected. In methods that require opening of the cranial bone, for example, a so-called microvascular decompression (Janetta operation). In this procedure, the nerve at the exit point from the brain is relieved by placing a cushion of muscle fibers or exogenous material between the nerve and the surrounding vessels.
Here, too, the early results are very good (freedom from pain or significant relief in 98% of cases), over a 10-year period the success rate drops to 67%. Side effects include loss of sensation in 3 – 30% of cases, in up to 5% also numbness in the ear of the treated side. Relatively new are radiosurgical procedures in which the irradiation of the trigeminal nerve near its exit point from the brain is performed.
Here, too, the success rates are good; they are about 85% pain-free initially, and 75% after 3 years. As with the other procedures, side effects may include loss of sensation in the area supplied by the trigeminal nerve. The operation according to Jannetta is a so-called microvascular decompression procedure.
This means that if there is close contact between the trigeminal nerve and a (in this case often calcified) vessel, a small piece of metal is inserted into it. The patient is under general anesthesia. This means that the nerve is no longer constricted by the hardened vessel and the irritation that was responsible for the pain is eliminated.
This surgical procedure has a very high success rate. The surgery after Jannetta, like any other surgical procedure, has certain risks. In rare cases, the proximity to one of the nerves responsible for hearing can lead to a restriction or loss of hearing on the affected side. Another rare complication is decreased sensation of touch or pain in the affected area of the trigeminal nerve.