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Trigeminal Neuralgia (Facial Nerve Pain) (cont.)

What Are the Medications for Trigeminal Neuralgia?

Doctors use 3 main drugs to treat trigeminal neuralgia-baclofen (Lioresal), carbamazepine (Tegretol), and phenytoin (Dilantin).

  • Baclofen is the safest of the 3, though less effective. Many doctors begin therapy with baclofen and monitor its results over a week's time.
  • For years, carbamazepine had been the mainstay for treating this disorder. In fact, many experts believe that if you get no relief from 2 days of carbamazepine treatment, doctors must reconsider the diagnosis of trigeminal neuralgia.
    • The side effects of this drug include dizziness, sedation, confusion, and rash.
    • The doctor likely will complete a series of blood and urine tests before beginning treatment to establish a baseline of laboratory values.
    • Carbamazepine in unusual instances causes a rare blood disease known as aplastic anemia.
    • Frequent blood monitoring avoids this problem. You can expect to take consistent doses of this medicine for about 6 months before your doctor reconsiders the dosing schedule.

Surgery for Trigeminal Neuralgia

If doctors clearly determine the cause of the disorder to be compression of an artery on the trigeminal nerve deep in your skull, a neurosurgeon can perform a microvascular decompression.

  • The surgeon moves the compressing artery to a location away from the compressed root of the nerve.
  • The major disadvantage is that it requires a neurosurgical operation-with all its complications-to get access to the root of the trigeminal nerve.

What Is the Prognosis for Trigeminal Neuralgia?

Doctors do not know how to prevent trigeminal neuralgia, to predict who will get it, or determine who will respond to a particular treatment until it is tried.

Clearly, though, the overwhelming majority responds to at least one of the treatments and can obtain excellent benefit from it.

More and more people find substantial relief from invasive treatment, either anesthetic injections or decompressive therapy. It is very rare that someone with trigeminal neuralgia does not obtain long-standing relief.

Picture of Facial Nerves

Nerves of the face that may be triggered.
Nerves of the face that may be triggered. Click to view larger image.

Medically reviewed by Joseph Carcione, DO; American board of Psychiatry and Neurology


"Trigeminal neuralgia"

Last Reviewed 11/21/2017
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Read What Your Physician is Reading on Medscape

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Trigeminal neuralgia (TN) is a common and potentially disabling pain syndrome, the precise pathophysiology of which remains obscure.

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