Trigeminal Neuralgia: Diagnosis and Treatment

Although the symptoms are so typical, there are still patients who are treated for dental or sinus problems. If trigeminal neuralgia is suspected, an MRI of the brain is done, especially in younger people (who are more likely to have a secondary form), to rule out underlying diseases and treat them if necessary.

What is the treatment for trigeminal neuralgia?

Even if a diagnosis of classic trigeminal neuralgia is made, it does not mean that a complete and long-term cure is always possible. Subsequent forms of treatment are available.

Tablets for trigeminal neuralgia

Because acute pain lasts such a short time, it can hardly be addressed with acute treatment; instead, regular preventive medication is used. Regular pain medications do not help. Instead, anticonvulsants or antiepileptics (for example, carbamazepine, oxcarbazepine, lamotrigine) are available, i.e., drugs that are otherwise used to treat convulsions.

In trigeminal neuralgia, however, the necessary dose is usually lower, and sometimes – by an experienced specialist – several agents must be combined. Unfortunately, the intensity and frequency of the pain attacks can usually be reduced, but not completely eliminated. If the pain ceases under therapy, after two months, an attempt can be made to slowly “phase out” the drugs again.

Injections as a new form of treatment

Recently, there have also been reports of the successful use of local injections of botulinum toxin – a neurotoxin that is also used for other pain syndromes. However, larger studies on this are still pending.

Sclerosing nerve conduction

Sclerotherapy is also called percutaneous thermocoagulation in medical jargon. During a brief anesthesia, heat is applied to the nerve node with a probe through a small incision in the skin, thereby cutting off nerve conduction. However, the effect wears off over time.

Surgery for trigeminal neuralgia

Modern methods include Janetta microvascular decompression, which does not damage the nerve. Under general anesthesia, a Teflon sponge is inserted between the nerve and vessels touching it to prevent pressure on the nerve. The recurrence rate is low; side effects may include hearing loss or facial numbness on the affected side.

Radiation: high relapse rate

With the so-called gamma knife (“radiation knife”), a newer radiosurgical method is available in which the affected nerve node is switched off extremely precisely by gamma rays. Unfortunately, the good results achieved so far are compromised by a relatively high recurrence rate.

Alternative Medicine

The efficacy of alternative procedures is controversial; acupuncture is quite well established. In homeopathy, Verbascum and Aconitum are primarily used for acute treatment; however, constitutional therapy with an experienced therapist is more recommended. Among the Schüßler salts, a trial of No. 7 Magnesium phosphoricum (applied as an ointment) is recommended.