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Treatment

Authoring team

The aim of treatment for trigeminal neuralgia is pain relief

  • medical management
    • carbamazepine
    • only drug licensed for trigeminal neuralgia in the UK
    • 70% of patients with trigeminal neuralgia have good initial pain control with carbamazepine (1)
    • side effects include: tiredness and poor concentration and there is a high risk of drug interactions.
    • oxcarbazepine
      • a keto derivative of carbamazepine
      • recommended as second line medicine
      • has shown similar efficacy to carbamazepine
    • baclofen
      • useful in multiple sclerosis and when combined with carbamazepine
    • lamotrigine
      • can be used with carbamazepine or oxcarbazepine (1)
  • surgical management
    • patients with poor control of pain while taking medications, may need surgical intervention.
    • surgical treatment falls in to two categories
  • palliative destructive procedures
    • involve partly controlled destruction of trigeminal nerve root with the aim to relieve pain
    • heat (radiofrequency lesioning), chemicals (with a viscous glycerol called glycerol rhizolysis), and mechanical (by crushing the nerve against surrounding bone and dural reflections called balloon compression) procedures are used
    • can be performed for all causes of trigeminal neuralgia
  • microvascular decompression:
    • aims to decompress the trigeminal nerve, and deals with the cause of trigeminal neuralgia in the 95% of cases not caused by other lesional causes (1)

In patients who present with severe unremitting pain, opiods will not control the symptoms. A lidocaine injected into the trigger point is much more effective in these patients (1).

NICE state (2):

  • offer carbamazepine as initial treatment for trigeminal neuralgia
  • if initial treatment with carbamazepine is not effective, is not tolerated or is contraindicated, consider seeking expert advice from a specialist and consider early referral to a specialist pain service or a condition-specific service

Reference:

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