How do I Choose the Best Trigeminal Neuralgia Treatment?

A. Pasbjerg
A. Pasbjerg

Trigeminal neuralgia is a condition with no definitive cause and no specific cure, and treatment is therefore focused on reducing or relieving the main symptom, severe facial pain. The most common treatments are medical; medication is typically the first course of action, with surgery as an alternative if drugs are ineffective. There is also some evidence that acupuncture may be a viable trigeminal neuralgia treatment for some patients. In order to choose the best treatment, patients should consult with their doctors to understand all of the alternatives and their risks, and pick the one that best meets their needs while also being aware that the treatment may need to be re-evaluated if it is not effective.

Drug therapy is often the first course of action in trigeminal neuralgia treatment. Antiseizure medications are often used, as they inhibit overactivity in the nerves; muscle relaxants may also be helpful. The most commonly used drugs are carbamazepine, baclofen, and phenytoin. These drugs can have serious side effects, which patients should be aware of, and in some cases it is important for the doctor to monitor them on an ongoing basis. Medications may also become less effective at controlling trigeminal neuralgia pain over time, and other options may need to be explored.

There are several surgical options designed to damage the trigeminal nerve in an attempt to block pain signals. Alcohol or glycerol may be injected into or around the nerve to numb or destroy it, or a dose of radiation may be used. Balloon compression can block signals along the nerve, or doses of electric current may be used to create lesions that damage it. Though usually effective, all of these options carry risk as they are neurosurgical procedures. Patients also often experience numbness, tingling, or weakness in their faces, and pain may return later, requiring additional procedures.

One surgical trigeminal neuralgia treatment that does not damage the nerve is microvascular decompression. This option is used specifically in cases where nearby blood vessels are compressing the nerve. The vessels are either moved away or removed entirely.

Those hoping to avoid the side effects of drugs or the risk of surgery may wish to try acupuncture as a trigeminal neuralgia treatment. Some studies have shown that the use of acupuncture can reduce or completely relieve the facial pain associated with the disorder. This form of treatment is not as well established as many of the medical options, but may be considered less risky than those alternatives.

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