Trigeminal Neuralgia

Introduction

Trigeminal neuralgia is one of the painful diseases that often occurs without an underlying cause. Those affected suffer from brief attacks of extreme pain in the facial area. The disease is named after the 5th cranial nerve, the so-called trigemnius nerve, in whose supply area the pain occurs.

What are the therapeutic options?

In the therapy of trigeminal neuralgia, various treatment options are used. These include among others: Carbamazepine, an anti-epileptic drug (actually used to treat seizures), is relatively well established in the treatment of trigeminal neuralgia, but studies are constantly being conducted to determine the effectiveness of other drugs. Phenytoin, another anti-epileptic drug, can be administered intravenously for acute treatment.

It is also possible to inject a local anaesthetic in the vicinity of the affected trigeminal branch in order to temporarily stop pain transmission. Symptoms can be reduced by blocking the ganglion stellate nerve plexus. In some patients, acupuncture seems to have an (additional) alleviating effect and alternative mesotherapy can also show success.

Only when the conservative treatment options have been exhausted will surgery be considered. Which procedure is used in each individual case requires careful consideration and should be clarified in consultation with the attending physician. For some patients, acupuncture seems to have a (additional) alleviating effect and alternative medical mesotherapy can also show success.

Only when the conservative treatment options have been exhausted will surgery be considered. Which procedure is used in each individual case requires careful consideration and should be clarified in consultation with the attending physician.

  • Drugs
  • Surgical intervention
  • Radiotherapeutic method
  • Alternative medicine

Medicines for the treatment of trigeminal neuralgia

In the case of trigeminal neuralgia, there is a prescribed scheme in the drug treatment. Normally, monotherapy, i.e. treatment with only one drug, is aimed at. If this does not work, the therapy is switched to another drug.

The preparations are mostly anti-epileptic drugs, which are used not only to treat epilepsies but also, among other things, for trigeminal neuralgia. Simple painkillers, such as paracetamol, are not used. The therapeutic agent of choice is carbamazepine, which is also popular in acute pain situations due to its rapid onset of action.

Alternatively, Oxacarbazepine may be given if the patient is poorly tolerated by carbamazepine or is taking other drugs that interact with it. If the trigeminal neuralgia does not improve, the patient is switched to a second choice of medication. These include, for example, gabapentin, which does not work as well but is better tolerated by many people.

Another second-choice drug is pregabalin, which also reduces the symptoms of trigeminal neuralgia, but rarely makes the pain disappear completely. Lyrica® is the trade name of an antiepileptic with the active ingredient pregabalin, which is used primarily for pain caused by nerves. In trigeminal neuralgia, it is a second-choice drug because it provides less pain relief than other drugs. However, the advantages of Lyrica are that it improves the overall symptoms and hardly interacts with other drugs. Side effects include weight gain, dizziness, dry mouth and erectile dysfunction.