Trigeminal Neuralgia Treatment Options
Causes of Trigeminal Neuralgia
Trigeminal neuralgia is caused by compression or irritation of the trigeminal nerve, the largest nerve in the head that carries sensation from the face to the brain. The exact cause is often unknown, but common causes include:
- A blood vessel pressing on the trigeminal nerve near the brainstem (the most common cause)
- A tumor near the trigeminal nerve or brainstem
- Scar tissue in the region of the trigeminal nerve after previous surgery
- Multiple sclerosis plaques near the trigeminal nerve
- Dural arteriovenous fistula, an abnormal connection between arteries and veins near the brainstem
- Skeletal abnormalities such as elongated skull bones that place pressure on the trigeminal nerve
Medication Management
Many patients can control their trigeminal neuralgia symptoms with medication alone. Commonly prescribed options include:
- Carbamazepine (Tegretol): As an anticonvulsant, carbamazepine is very effective for nerve pain and is often the first-line drug treatment tried. Side effects can include drowsiness.
- Oxcarbazepine (Trileptal): Similar in structure and effects to carbamazepine but generally better tolerated with fewer drug interactions and side effects.
- Baclofen: A muscle relaxant and antispasmodic that can help when pain is contributed by muscle tension.
- Pregabalin (Lyrica): An Trigeminal Neuralgia Treatment to gabapentin that binds calcium channels and may provide relief of nerve pain.
- Tricyclic antidepressants: Amitriptyline and nortriptyline can help by inhibiting neurotransmitters involved in pain signaling.
Surgical Trigeminal Neuralgia Treatment
When medications don't adequately control symptoms, invasive procedures may be considered:
- Gamma Knife radiosurgery: Highly focused radiation is delivered to lesions compressing the trigeminal nerve to reduce swelling and damage the nerve fibers transmitting pain signals. Provides long-term remission in roughly 75% of cases.
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