Trigeminal Neuralgia - Treatment

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What is the treatment for trigeminal neuralgia?

  • Idiopathic trigeminal neuralgia most often is treated with good success using a single anticonvulsant medication such as carbamazepine (Tegretol).
  • Gabapentin (Neurontin, Gabarone), baclofen and phenytoin (Dilantin, Dilantin-125) may be used as second line drugs, often in addition to carbamazepine. In many patients, as time progresses, carbamazepine becomes less effective and these drugs can be used in combination to control the pain.
  • Should pain persist and medication fail to be effective, surgery or radiation therapy may be other treatment options.
  • Lamotrigine (Lamictal) may be prescribed for multiple sclerosis patients who develop trigeminal neuralgia.
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Comment from: Dorothy, 55-64 Female (Patient) Published: April 30

I developed zoster shingles December 2013. Pain started in the back of my right eyeball and worked its way into the forehead and cranial area. I was diagnosed with a migraine. The shingles placed me in the hospital 3 times (21 days) and developing cellulitis from the hospital. I have been told in the last 16 months it's the worst ever seen. I am seeing Internal Medicine, Infectious Disease, neurologist, lung specialist, eye doctor, oculoplastic surgeon at this time monthly. Because of the nerve pain from trigeminal neuropathy (TN) and swelling from my eyebrow to cranium I cannot see a dermatologist yet. I have been on every pain medicine. Nothing works! Medication of 3600 mg of gabapentin causes hallucinations. I am now on Gralise 1800mg which is gabapentin used as a time release pill. Thirteen months ago I developed 2 extra rows of eye lashes growing downward on my cornea and since then I've had to have 19 lashes extracted every 3 weeks. The medicines I was given for pain caused me to be on a (Lyrica) respiratory machine for 12 hours a day. I have not been able to have surgery on my eye lid. The doctors said I'm at too much risk to be put to sleep. March 2015 I was referred to see an oculoplastic surgeon. He was able to deaden the eyelid and cut out the extra rows of lashes and gave me a steroid shot in the 2 optic nerves to block the pain. The next day all of the nerves from the optic nerves to the cranial area got ticked off, the nerve block shots did not work. Three weeks later I followed up and 5 more eye lashes have developed growing and are scratching my cornea. The oculoplastic surgeon suggested to cut out the two optic nerves above the eye to relieve me from all TN pain forever, as well as do electrolysis on the new 5 lashes. The drawback is that the right side of my face and cranium will be numb forever.

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Comment from: Betsy, Female (Patient) Published: February 16

I started having severe pain in 2009. It took my doctor a long time to diagnose trigeminal neuralgia. I was on 5 Tegretol and 4 gabapentin a day. A friend told me about this doctor and I got an appointment and saw him, he was great. I had the operation in June 2011 and after such intense pain I have not a twinge since.

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