Treating Trigeminal Neuralgia During an Episode

Trigeminal neuralgia is a type of neuropathic pain that can be either primary or secondary in nature. Secondary trigeminal neuralgia may develop as a result of underlying conditions such as intracranial tumors, dental inflammation, or nasal-related diseases, since the sensory supply to the teeth is managed by the trigeminal nerve. On the other hand, primary trigeminal neuralgia occurs without any identifiable structural damage and is characterized by sudden, shock-like facial pain that comes and goes unpredictably.

Medication as First-Line Treatment

Pharmacological therapy remains the foundation of treatment for trigeminal neuralgia. Approximately 70% of patients find adequate pain relief through medication. The most commonly prescribed drugs are sodium channel blockers, including carbamazepine and oxcarbazepine. These medications help reduce the abnormal nerve activity responsible for the painful episodes. However, because these drugs have a sedative effect on the nervous system, they can cause side effects such as dizziness, drowsiness, and in some cases, liver dysfunction or a decrease in white blood cell count.

Minimally Invasive Procedures for Drug-Resistant Cases

For patients who cannot tolerate the side effects of medication or experience inadequate relief, interventional treatments such as radiofrequency thermocoagulation offer a promising alternative. This procedure targets specific branches of the trigeminal nerve depending on the location of the pain. For example, if the first branch is affected, the supraorbital foramen is targeted. For the second branch, the infraorbital or mental foramen may be treated. When multiple branches are involved, the Gasserian ganglion—located at the skull base and serving as the first-order neuron of the trigeminal nerve—can be addressed using either radiofrequency ablation or balloon compression techniques.

Advanced Treatment Options

In cases where the neuralgia is caused by vascular compression, more advanced techniques like microvascular decompression, glycerol rhizotomy, or gamma knife radiosurgery may be considered. Each of these methods has its own set of advantages and potential risks. Microvascular decompression, for instance, involves surgical repositioning of blood vessels that may be compressing the nerve, while gamma knife offers a non-invasive radiation-based approach.

Choosing the Right Treatment

For patients experiencing frequent relapses or those suffering from involvement of multiple trigeminal nerve branches, balloon compression can be a particularly effective and less invasive solution. Both radiofrequency thermocoagulation and balloon compression are widely regarded as safe, effective, and minimally invasive techniques for managing trigeminal neuralgia, offering long-term pain relief with minimal recovery time.