The Facial Pain Association is committed to providing current and accurate information in the effort to educate patients and medical professionals. FPA does not recommend one treatment for neuropathic facial pain over another. There can be side effects associated with any treatment for facial pain and it is recommended that you discuss the potential side effects with a skilled and knowledgeable doctor before selecting a treatment.
Treatment with Medications
Anticonvulsant medications, which slow down the nerve’s conduction of pain signals, are usually the first treatment option. These include:
Tegretol (carbamazepine) is the primary drug used to treat TN. Many physicians believe that the relief of facial pain with Tegretol confirms the diagnosis of TN.
Microvascular Decompression (MVD)
MVD is the most invasive of all surgical options to treat TN, but it also offers the lowest probability that the pain will return. This surgical treatment was designed to cause no additional nerve damage. The procedure requires a small opening to be made behind the ear. While viewing the trigeminal nerve through a microscope, the surgeon places a soft cushion between the nerve and the offending blood vessels.
This is an outpatient procedure, although sometimes the patient is kept overnight. It is performed in the operating room, with the patient receiving general anesthesia. In this percutaneous procedure, a cannula is inserted through a puncture in the cheek and guided to a natural opening in the base of the skull. A soft catheter with a balloon tip is threaded through the cannula. The balloon is inflated, squeezing the nerve against the edge of the dura and the petrous bone. Balloon compression works by selectively injuring nerves which mediate light touch.
Glycerol Injection is also an outpatient or overnight procedure. It is performed with intravenous sedation. A thin needle is introduced through a puncture in the cheek, next to the mouth and guided through a natural opening in the base of the skull. Just inside this opening is the trigeminal ganglion where all three nerves come together. Glycerol bathes the ganglion and affects the demyelinated fibers.
Typically performed in an outpatient setting, the patient is sedated for a few minutes while a needle is passed though the cheek, up thorough a natural opening in the base of the skull. The patient is awakened and a small electric current is passed through the needled causing tingling. When the needle is positioned so the tingling occurs in the same area of TN pain, the patient is sedated again and a radiofrequency current is passed through the needle to intentionally destroy part of the nerve.
Radiosurgery (GammaKnife, CyberKnife, etc.)
A non-invasive procedure performed on an outpatient basis; it requires no incision but may require the attachment of a head frame. Highly focused beams of radiation are directed to the area where the trigeminal nerve exits the brainstem. The radiation causes the slow formation of a lesion on the nerve that disrupts the transmission of pain signals to the brain. However, pain relief from this procedure may take several months.
Complementary and Alternative Medications (CAM)
As in traditional medical treatments, the effectiveness of all CAM treatments depends on several things, including the person’s state of health, and the skill and knowledge of the practitioner. Every person responds differently to treatments, and even though most of these remedies are non-invasive, they still may have potential risk and complications.
- Nutritional therapy
- Electrical Nerve Stimulation
- TENS (Transcutaneous Electrical Nerve Stimulation)
- Upper cervical chiropractic
- Vitamin B-12 Injections
- Vitamin Therapy