Atypical trigeminal neuralgia is more difficult to treat, both with medications and surgery.
Surgery may result in areas of numbness to the patient and lead occasionally to "anesthesia dolorosa," which is numbness with intense pain. Many people do find dramatic relief with minimal side effects from the various surgeries that are available.
Medications
Some treatments have involved anticonvulsants such as carbamazepine, topiramate, phenytoin, or gabapentin. Anticonvulsant effects may be potentiated with an adjuvant such as baclofen or clonazepam. Baclofen may also help some patients eat more normally if jaw movement tends to aggravate the symptoms.Pain may be treated long-term with an opioid such as methadone in some patients, but due to the nature of the neuralgia, traditional analgesics typically have negligible effect.
Low doses of some antidepressants such as nortriptyline can also be effective in treating neuropathic pain.
Botox can be injected into the nerve by a physician, and has been found helpful using the "migraine" pattern adapted to the patient's special needs.
Many patients can not tolerate medications for years, and an alternate treatment is to take a drug such as gabapentin and place it in an externally applied cream base by a pharmacist who compounds drugs.
Surgery
Surgery may be recommended, either to relieve the pressure on the nerve or to damage it further to prevent the transmission of pain. Surgery is effective in more than 75% of people with classic trigeminal neuralgia.The nerve can also be damaged to prevent pain signal transmission using a gamma knife. This is used especially for those people who are medically unfit for a long general anaesthetic, or who are taking medications for prevention of blood clotting (e.g., warfarin).
Excellent success rates using a cost effective percutaneous surgical procedure known as balloon compression have been reported. This technique has been helpful in treating the elderly for whom surgery may not be an option due to coexisting health conditions. Balloon compression is also the best choice for patients who have ophthalmic nerve pain or have experienced recurrent pain after microvascular decompression.
Alternative and Complementary Treatments
Alternative and complementary health care treatments such as chiropractic or acupuncture are sometimes used either in combination with drugs or alone to help manage pain. Capsaicin can be helpful in short term temporary pain control of trigeminal neuralgia. It works by overstimulating the nerve endings at the site of current trip points on the face.Some patients have found relief with keeping the face covered.
In one case of trigeminal neuralgia associated with tongue-piercing, the condition resolved after the jewelry was removed.
