Trigeminal Neuralgia Treatment

Are Your Symptoms Trigeminal Neuralgia?

If you have facial pain but you're not sure if you have trigeminal neuralgia, take our online risk assessment to learn more. We'll ask you a series of questions. After you answer all the questions, you will receive recommended next steps based on your answers.

Take the Risk Assessment

If your answers suggest that you might have trigeminal neuralgia, our neurology team will guide you through next steps including the advanced treatment options available at Baystate Health. Learn about those treatment options below, and call us if you have questions: 413-794-5600.

Advanced Procedures to Relieve Your Pain

If you’ve been diagnosed with trigeminal neuralgia, you can get relief from the severe facial pain this condition causes. Our expert neurosurgeons at Baystate Health are here for you.

No other healthcare provider in western Massachusetts provides treatment for trigeminal neuralgia, and we treat more patients with this condition than many of the state’s largest medical institutions. We see patients with trigeminal neuralgia who come to us from throughout the country and world because of our expertise. We’ll work with you to create a customized treatment plan based on your symptoms, concerns, and needs.

Medical Therapy for Trigeminal Neuralgia

Your treatment plan likely will start with prescription medications. The medication we use most often to treat trigeminal neuralgia is carbamazepine (Tegretol or Carbatrol). This is part of a class of medications called anticonvulsants, which we use most often to treat seizures. If carbamazepine isn’t a good choice for you, your doctor may recommend another anticonvulsant instead. Your doctor may adjust your dosage until you have the most pain relief with the fewest side effects.

As with any medication, you may experience side effects from your treatment. Side effects from carbamazepine and other anticonvulsant medications can include:

Confusion
Dizziness
Drowsiness
Fatigue
Memory loss
Nausea

In addition, you may become resistant to carbamazepine therapy over time. This can lead to you getting less benefit from the medication even after your doctor increases the dose you take. If this happens, you and your doctor may need to discuss surgical treatment for your trigeminal neuralgia.

Surgical Treatment for Trigeminal Neuralgia

There are several procedures available to treat trigeminal neuralgia if medication therapy is no longer enough or if you’re not a good candidate for it.

Microvascular Decompression (Jannetta Procedure)

Microvascular decompression (MVD, also known as the Jannetta procedure) was named after its creator, Dr. Peter J. Jannetta. Dr. Kamal Kalia of Baystate Neurosurgery was trained by Dr. Jannetta himself.

Before this procedure, you’ll have a magnetic resonance imaging (MRI) exam so we can be sure of what is causing your trigeminal neuralgia. In most cases, trigeminal neuralgia is the result of a blood vessel making contact with the trigeminal nerve in the face. If that’s the case, you may be a good candidate for MVD.

You’ll be asleep during MVD surgery. Your surgeon will make a small incision behind the ear on the side of your skull where you experience pain. Next, your surgeon will create a small hole in your skull through that incision. We’ll use a microscope to see inside the incision and locate the blood vessel pressing on your trigeminal nerve. Once we do, we’ll move the blood vessel away from the nerve and use a Teflon pad to keep the vessel from touching the nerve again.

We complete MVD surgery in about two hours, and you’ll stay in the hospital for two to three days to recover. Due to our vast experience with this procedure, patients who undergo MVD surgery with us usually have shorter hospital stays and faster recoveries with us versus other providers.

About 80% of patients experience relief from their trigeminal neuralgia facial pain after MVD.

MVD can also be used to treat hemifacial spasm (face twitching or spasms on one side of the face). Your doctor may recommend surgery, oral medication, Botox® injections to treat this rare condition.

Glycerol Rhizotomy

Glycerol rhizotomy is a treatment option we use if your trigeminal neuralgia is the result of Multiple Sclerosis (MS). We may recommend this procedure if you’re not healthy enough for MVD surgery. Some patients who don’t have MS also choose glycerol rhizotomy because it’s less invasive and doesn’t involve brain surgery.

You’ll be asleep for this procedure. Your surgeon will insert a needle through your face and into an area called the trigeminal cistern, which surrounds the part of the trigeminal nerve that sends pain signals to the brain. The surgeon will inject a medication called glycerol, which blocks pain signals from traveling from the trigeminal nerve to the brain.

You’ll go home within a few hours of your glycerol rhizotomy. The procedure has a low risk of causing facial numbness or tingling. Unlike MVD surgery, glycerol rhizotomy usually only provides pain relief for one to three years. However, we can repeat the procedure if your symptoms start to return.

Other Trigeminal Neuralgia Treatments

There are additional treatment options available for trigeminal neuralgia, such as radiosurgery (Gamma Knife), balloon compression, and others. You and your surgeon will work together to decide whether these procedures are right for you if you aren’t a good candidate for either MVD or glycerol rhizotomy.