Trigeminal Neuralgia
Medications
Medication by mouth is almost always the first treatment for trigeminal neuralgia (TN). If medication does not help or you have too many side effects, more invasive treatments such as injections and/or surgery may be tried. You may need one or a combination of medication and other treatments. For example, you may use injections and biofeedback or a combination of medicines and dietary supplements to manage your pain.
Carbamazepine is often the medicine of choice for TN. It belongs to a class of medicines called anti-convulsants or anti-epileptic drugs (AED), which are used to treat seizures. These medicines are believed to be effective because the abnormal electrical impulses that produce pain in TN are similar to those in people with seizure disorders.
People with newly diagnosed TN tend to have pain relief with carbamazepine, at least for a while. Pain relief from this medicine can be a powerful sign that a person does indeed have TN instead of some other type of pain problem. However, a person may not get pain relief from carbamazepine if his or her case is not typical or classic TN.
Carbamazepine is usually started at a low dose, perhaps 100 mg once or twice daily. Patients who start at too high a dose will commonly develop side effects that cause them to have to stop the medication. Many of these side effects can be avoided simply by beginning at a small dose and gradually increasing the amount of medicine every few days. Some patients have pain relief with a small dose of medication while others may need higher doses. Generally, the upper dose limit is around 1200 mg per day, although some patients take higher daily doses without problems. The most common side effects include drowsiness, dizziness, upset stomach and mental dullness. People taking this medicine may need to have blood tests every few months to check for side effects in their kidneys, liver and bone marrow.
Although this is probably the most common medication for TN, other medications are listed below. If you have questions about how these medications are used, ask your health care provider.
Baclofen belongs to a class of medicines called “anti-spasmodics” or muscle relaxants. It may be given if anti-convulsants do not work or are no longer effective in relieving your pain. Baclofen also may be given together with an anti-convulsant to provide better relief of your pain. Like anti-convulsants, baclofen may lose its ability to relieve TN pain over time. Side effects are drowsiness, upset stomach and confusion.
Other Medications
Carbamazepine (Tegretol, Carbatrol)
Carbamazepine is often the medicine of choice for TN. It belongs to a class of medicines called anti-convulsants or anti-epileptic drugs (AED), which are used to treat seizures. These medicines are believed to be effective because the abnormal electrical impulses that produce pain in TN are similar to those in people with seizure disorders.
People with newly diagnosed TN tend to have pain relief with carbamazepine, at least for a while. Pain relief from this medicine can be a powerful sign that a person does indeed have TN instead of some other type of pain problem. However, a person may not get pain relief from carbamazepine if his or her case is not typical or classic TN.
Carbamazepine is usually started at a low dose, perhaps 100 mg once or twice daily. Patients who start at too high a dose will commonly develop side effects that cause them to have to stop the medication. Many of these side effects can be avoided simply by beginning at a small dose and gradually increasing the amount of medicine every few days. Some patients have pain relief with a small dose of medication while others may need higher doses. Generally, the upper dose limit is around 1200 mg per day, although some patients take higher daily doses without problems. The most common side effects include drowsiness, dizziness, upset stomach and mental dullness. People taking this medicine may need to have blood tests every few months to check for side effects in their kidneys, liver and bone marrow.
Although this is probably the most common medication for TN, other medications are listed below. If you have questions about how these medications are used, ask your health care provider.
- Gabapentin (Neurontin)
- Lamotrigine (Lamictal)
- Levateracitam (Keppra)
- Oxcarbazepine (Trileptal)
- Phenytoin (Dilantin)
- Pregabalin (Lyrica)
- Topirimate (Topamax)
- Valproic acid (Depakote)
Baclofen (Lioresal)
Baclofen belongs to a class of medicines called “anti-spasmodics” or muscle relaxants. It may be given if anti-convulsants do not work or are no longer effective in relieving your pain. Baclofen also may be given together with an anti-convulsant to provide better relief of your pain. Like anti-convulsants, baclofen may lose its ability to relieve TN pain over time. Side effects are drowsiness, upset stomach and confusion.
Other Medications
- Clonazepam (Klonopin) – This drug belongs to a class of medicines called benzodiazepines. Its effect on nerve signals is similar to the effect of anti-convulsants, and it has similar side effects.
- Anti-depressants – Drugs from this class of medicine are sometimes used but often do not help to relieve TN pain. Anti-depressants were originally used to treat depression and other related disorders. Now some of them are also used to treat TN. Examples include amitriptyline (Elavil), desipramine (Norpramin) and nortriptyline (Pamelor).
- Opioids – These drugs are often called narcotics. Opioids are sometimes given for treatment of TN but often do not relieve the pain. You may be given an opioid after trying other medicines first. You may take an opioid in combination with one or more other medicines to manage your pain. Opioids have more serious side effects than other classes of medicine and possible problems with addiction. Examples of opioids are methadone and morphine.