Trigeminal neuralgia medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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There is no cure for trigeminal neuralgia, but most people find relief from medication or sometimes from one of the many so-called complementary or alternative therapies. Atypical trigeminal neuralgia, which involves a more constant and burning pain, is more difficult to treat, both with medications and surgery. During a TN attack, some patients may get quick relief by applying an ice pack or a readily available source of cold temperature to the area of pain.

• Anticonvulsants such as carbamazepine, oxcarbazepine, topiramate, phenytoin, or gabapentin are generally the most effective medications. Pain relievers usually do not help. Anticonvulsant effects may be potentiated with an adjuvant such as baclofen or clonazepam. Baclofen may also help some patients eat more normally if jaw movement tends to aggravate the symptoms.

• If anticonvulsants don’t help and surgical options have failed or are ruled out, the pain may be treated long-term with an opioid such as methadone.

• Low doses of some antidepressants can be effective in treating neuropathic pain.

• Botox can be injected into the nerve by a physician, and has been found helpful using the migraine pattern adapted to the patient’s special needs.

Many patients cannot tolerate medications for years, and an alternate treatment is to take a drug such as gabapentin and place it in an externally applied cream base by a pharmacist who compounds drugs. Also helpful is taking a drug holiday when remissions occur and rotating medications if one becomes ineffective.

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