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Q: I was diagnosed with trigeminal neuralgia after complaining about sharp pains in my face. I am working with a neurologist to find an effective pain reliever. I'm wondering, though, what causes the pain? How does a person know which medications are most likely to help? What else can I do besides take drugs to help decrease the bouts of pain, both the number and severity?

A: Trigeminal neuralgia is a condition that causes episodes of severe, sharp or shock-like pain on one side of the face where branches of the trigeminal nerve (the nerve responsible for sensation in the face) are located. Often there is a brief spasm of facial muscles (or tic). Another name for this condition is tic douloureux (meaning "painful spasm").

Sometimes a cause of trigeminal nerve compression or irritation is found, such as:

  • Aneurysms or other abnormal blood vessels
  • Meningitis (inflammation of the lining of the brain)
  • Tumor
  • Multiple sclerosis

But most of the time, no cause can be found. In such cases, the disorder may be called "classic" or "idiopathic" trigeminal neuralgia.

It's impossible to know in advance which medications are most likely to help. Studies of other patients with trigeminal neuralgia are the best source of information to guide treatment. While a host of different medicines have been used, carbamazepine (Tegretol), oxcarbazepine (Trileptal), baclofen (Lioresal) and lamotrigine (Lamictal) are among the most effective and most commonly used.

The only non-medication approach commonly used to treat trigeminal neuralgia is surgery. A number of surgical options are available, ranging from a major operation (requiring an incision through the skull) to more minor procedures. However, their effectiveness is far from 100% and they are associated with significant risks.

There are reports of acupuncture, homeopathy and other complementary and alternative treatments being helpful in reducing the pain of trigeminal neuralgia. However, I could find no convincing studies of these or other non-medication, non-surgical treatments. That may just mean that such treatments have not yet been well-studied; or they may not work.

Trigeminal neuralgia is a difficult disease to tolerate, but most people suffering with it eventually find relief. You're doing the right thing by talking with your doctor about your condition and about all of your treatment options.