The treatment of trigeminal neuralgia (TN) usually starts with medication. While some people can stay on medications for life to control TN, others may need injections or surgeries due to negative side-effects/ineffectiveness of medications from continued use. This page discusses the common treatment medications and other non-invasive therapies used for TN.

Medications help control the pain in trigeminal neuralgia and are generally taken long-term.

Medications for Trigeminal Neuralgia

Medications are mainly used to control the pain in TN, and do not treat the cause of TN. For this reason, medications are generally taken long-term, as long as the underlying causes are at work.

The medications for TN can be grouped under those used in first-line therapy, second-line therapy, and alternative medications.1 Each of these classes is described below.

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First-line therapy for trigeminal neuralgia
First-line therapy for TN consists of using anticonvulsant drugs.1,2 These drugs act by blocking voltage-sensitive sodium channels in the nerve cells, which results in stabilization of hyper-excited nerves and prevents repetitive firing of pain signals. One of the following two anticonvulsant drugs is typically tried first for TN:

  • Carbamazepine. Carbamazepine is known to act quickly, even in low doses, to provide immediate relief from the sharp pain attacks of TN. Compared to the other first-line therapy (oxcarbazepine), carbamazepine may have a marginally higher efficacy but also an increased risk of serious side effects in some people.3,4 For example, the US Food and Drug Administration (FDA) recommends Asians to be genetically tested before taking carbamazepine, due to a higher risk of developing Stevens-Johnson syndrome.2
  • Oxcarbazepine. Oxcarbazepine is effective in treating TN and has fewer or milder side effects; however, the efficacy of carbamazepine may be marginally higher.3,4 The typical sharp, stabbing pain of TN is well controlled by oxcarbazepine, and it is widely used as a substitute for carbamazepine.

Both, carbamazepine and oxcarbazepine may cause side effects, such as drowsiness, nausea, dizziness, double vision, inflamed liver, allergic rash, and other blood disorders. They may also adversely interact with other drugs, such as antacids, MAO-inhibiting antidepressants, and birth-control pills. Due to the risk of various side effects and drug interactions, it is advisable to treat TN with anticonvulsant drugs under strict supervision by a doctor.

Second-line Therapy for Trigeminal Neuralgia
If the first-line medications do not respond or have serious side effects, second-line medications may be prescribed. Commonly used second-line medications are:

  • Lamotrigine, an anticonvulsant drug, acts by slowing the release of glutamate—an amino acid that’s important in transmitting pain signals to the brain.
  • Baclofen, a muscle relaxant, acts by mimicking brain chemicals that slows nerve transmission. This drug also provides relief from muscle spasm and cramps and is commonly used as an add-on drug in patients who have TN from multiple sclerosis.4
  • Pimozide, an antipsychotic drug has good efficacy in treating TN pain. The exact mechanism of action of pimozide in treating TN is unknown.

Medications used as second-line therapy may either be used as individual treatment methods, or as add-ons to the first line medications.

Alternative treatment options for trigeminal neuralgia
Other anticonvulsant drugs, such as phenytoin, clonazepam, gabapentin, pregabalin, topiramate, levetiracetam, valproate, and tocainide may be used as add-ons to ongoing TN treatment for improved efficacy or to avoid specific side effects.

Sometimes, the effectiveness of a well-responding medicine may reduce over time as a result of the body adjusting to the medication, or the nerve injury may continue to progress. In such cases, increasing the dosage or switching to other medications may help.

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Other Therapies for Trigeminal Neuralgia

Nutritional supplements, lifestyle changes, and other non-invasive therapies may be used in conjunction with medications to provide relief from TN pain. A few examples include herbs, vitamins, upper-cervical chiropractic therapy, massage, acupuncture, craniosacral therapy, biofeedback, hypnosis, and following a healthy diet.

Alternate therapies and nutritional supplements have yet to be proven effective for trigeminal neuralgia pain in clinical studies, so more research is required to establish their safety and effectiveness.

References

  • 1.Obermann, M, Katsarava, Z, Holle, D. An update on emerging therapeutic options for the treatment of trigeminal neuralgia. Expert Opinion on Orphan Drugs (2017), 5(11), 859–863. doi:10.1080/21678707.2017.1394183
  • 2.Obermann M. Treatment options in trigeminal neuralgia. Ther Adv Neurol Disord. 2010;3(2):107-15.
  • 3.Cregg, R, Besi, E, Boniface, D, Zakrzewska, J. EHMTI-0355. Comparison of carbamazepine and oxcarbazepine tolerability in patients with trigeminal neuralgia. The Journal of Headache and Pain (2014), 15(S1). doi:10.1186/1129-2377-15-s1-i2
  • 4.Weigel G, Casey FK, Striking Back! The Trigeminal Neuralgia and Face Pain Handbook. 4th ed. Florida:Trigeminal Neuralgia Association; 2004.
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