Pain can usually be treated successfully with medication, injections, or surgery.

pharmaceuticals

Traditional painkillers (paracetamol, acetylsalicylic acid, etc.) or even morphine (source 3) cannot effectively relieve pain. facial neuralgia. Other much more effective drugs are used, including:

• The anticonvulsivants (antiepileptic), having the effect of stabilizing the membrane of nerve cells, often with carbamazepine in first intention (Tegretol®) which makes it possible to eliminate painful crises or to reduce their frequency and intensity, or even gabapentin (Neurontin®) , oxcarbazepine (Trileptal®), pregabalin (Lyrica®), clonazepam (Rivotril®), phenytoin (Dilantin®); lamotrigine (Lamictal®)

• The antispasmodics, such as baclofen (Liorésal®) can also be used.
• The Antidepressants (clomipramine or amitryptiline), anxiolytics and neuroleptiques (haloperidol) can be used as a supplement.

surgery

Although drug treatments are effective in the majority of cases, around 40% of patients end up developing long-term resistance. It is then necessary to consider a surgical intervention.

There are currently three different techniques:

• Le gamma-knife (gamma ray scalpel) consisting in irradiating the trigeminal nerve at its junction with the brain with radioactive rays which will cause the partial destruction of the nerve fibers. (source 3)
• The percutaneous techniques here aiming to directly reach the nerve or its ganglion using a needle inserted into the skin and this, under strict radiological or stereotaxic control. Three techniques are possible:
  1. Thermocoagulation (selective destruction of the Gasser’s ganglion by heat) which eliminates pain while maintaining tactile sensitivity of the face. It is the most effective percutaneous method.
  2. Chemical destruction (injection of glycerol)
  3. Compression of the Gasser’s ganglion by an inflatable balloon.
• La microvascular decompression by direct approach of the trigeminal which consists in making an opening in the skull, behind the ear, in search of the blood vessel responsible for the compression. It is therefore a delicate and invasive procedure.

These neurosurgical procedures can lead to certain complications, such as loss of facial sensitivity for example. In some people with trigeminal neuralgia, the pain may return after a few years. The choice of treatment depends on the age, the condition of the patient, the intensity of the neuralgia (tolerance to pain and spasms of the affected person), its origin or its seniority. Generally speaking, surgery is only considered as a last resort.