Trigeminal Neuralgia: Comprehensive Treatment Strategies in a Multidisciplinary Approach – A Literature Review
DOI:
https://doi.org/10.12775/JEHS.2026.87.67616Keywords
trigeminal neuralgia, neuropathic pain, facial pain syndromes, pharmacological treatmentAbstract
Introduction. Trigeminal neuralgia (TN) is a rare but debilitating craniofacial pain disorder characterized by sudden, severe, electric shock-like episodes affecting one or more branches of the trigeminal nerve. Despite its low prevalence, TN has a profound impact on quality of life. Accurate diagnosis and subtype classification are essential for guiding treatment. Advanced neuroimaging techniques help identify structural causes and guide therapy.
Purpose. This review offers a comprehensive, evidence-based summary of current treatment strategies for TN, including pharmacological, surgical, and supportive modalities. Special attention is given to recent advances and options for patients with refractory or complex cases.
Materials and Methods. This review is based on a structured analysis of peer-reviewed literature retrieved from PubMed, Google Scholar, and the Cochrane Library. Selection prioritized systematic reviews, randomized controlled trials, clinical guidelines, and high-quality cohort studies published between 2000 and 2024. Emphasis was placed on clinical relevance and methodological rigor.
Conclusion. Effective management of trigeminal neuralgia demands an individualized, stepwise approach. While carbamazepine and oxcarbazepine remain first-line treatments, a significant subset of patients requires surgical or adjunctive therapies. Microvascular decompression offers the best long-term outcomes in classical TN, whereas less invasive procedures and botulinum toxin injections may benefit selected patients. Neuromodulation techniques are emerging alternatives for drug-resistant cases. Multidisciplinary care is essential for accurate diagnosis and individualized treatment.
References
[1] Cruccu G, Finnerup NB, Jensen TS, et al. Trigeminal neuralgia. Neurology. 2016;87(2):220-228. https://doi.org/10.1212/wnl.0000000000002840
[2] Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ. 2014;348(feb17 9):g474. https://doi.org/10.1136/bmj.g474
[3] Zakrzewska JM, McMillan R. Trigeminal neuralgia: the diagnosis and management of this excruciating and poorly understood facial pain. Postgraduate Medical Journal. 2011;87(1028):410-416. https://doi.org/10.1136/pgmj.2009.080473
[4] Katusic S, Williams DB, Beard M, Bergstralh EJ, Kurland LT. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945-1984. Neuroepidemiology. 1991;10(5-6):276-281. https://doi.org/10.1159/000110284
[5] Love S. Trigeminal neuralgia: Pathology and pathogenesis. Brain. 2001;124(12):2347-2360. https://doi.org/10.1093/brain/124.12.2347
[6] Jannetta PJ. Arterial Compression of the Trigeminal Nerve at the Pons in Patients with Trigeminal Neuralgia. Journal of Neurosurgery. 1967;26(1part2):159-162. https://doi.org/10.3171/jns.1967.26.1part2.0159
[7] Obermann M, Yoon M s, Ese D, et al. Impaired trigeminal nociceptive processing in patients with trigeminal neuralgia. Neurology. 2007;69(9):835-841. https://doi.org/10.1212/01.wnl.0000269670.30045.6b
[8] Siqueira SRDT, Alves B, Malpartida HMG, Teixeira MJ, Siqueira JTT. Abnormal expression of voltage-gated sodium channels Nav1.7, Nav1.3 and Nav1.8 in trigeminal neuralgia. Neuroscience. 2009;164(2):573-577. https://doi.org/10.1016/j.neuroscience.2009.08.037
[9] Truini A, Prosperini L, Calistri V, et al. A dual concurrent mechanism explains trigeminal neuralgia in patients with multiple sclerosis. Neurology. 2016;86(22):2094-2099. https://doi.org/10.1212/WNL.0000000000002720
[10] Dilwali S, Mark I, Waubant E. MRI lesions can often precede trigeminal neuralgia symptoms by years in multiple sclerosis. Journal of Neurology Neurosurgery & Psychiatry. 2022;94(3):189-192. https://doi.org/10.1136/jnnp-2022-330172
[11] Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. https://doi.org/10.1177/0333102417738202
[12] Scholz J, Finnerup NB, Attal N, et al. The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. Pain. 2018;160(1):53-59. https://doi.org/10.1097/j.pain.0000000000001365
[13] Benoliel R, Svensson P, Evers S, et al. The IASP classification of chronic pain for ICD-11: chronic secondary headache or orofacial pain. Pain. 2018;160(1):60-68. https://doi.org/10.1097/j.pain.0000000000001435
[14] International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia. 2020;40(2):129-221. https://doi.org/10.1177/0333102419893823
[15] Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G. Trigeminal neuralgia – diagnosis and treatment. Cephalalgia. 2017;37(7):648-657. https://doi.org/10.1177/0333102416687280
[16] Cruccu G, Di Stefano G, Truini A. Trigeminal neuralgia. New England Journal of Medicine. 2020;383(8):754-762. https://doi.org/10.1056/nejmra1914484
[17] Wiffen PJ, Derry S, Moore RA, Kalso EA. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Library. 2014;2019(5). https://doi.org/10.1002/14651858.cd005451.pub3
[18] Cruccu G, Truini A. Refractory trigeminal neuralgia. CNS Drugs. 2012;27(2):91-96. https://doi.org/10.1007/s40263-012-0023-0
[19] Sindou M, Leston JM, Decullier E, Chapuis F. MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA. Operative Neurosurgery. 2008;63(4):341-351. https://doi.org/10.1227/01.neu.0000327022.79171.d6
[20] Barker FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The Long-Term Outcome of Microvascular Decompression for Trigeminal neuralgia. New England Journal of Medicine. 1996;334(17):1077-1084. https://doi.org/10.1056/nejm199604253341701
[21] Taha JM, Tew JM. Comparison of surgical treatments for trigeminal neuralgia: Reevaluation of radiofrequency rhizotomy. Neurosurgery. 1996;38(5):865-871. https://doi.org/10.1097/00006123-199605000-00001
[22] Guo S, Chao ST, Reuther AM, Barnett GH, Suh JH. Review of the Treatment of Trigeminal Neuralgia with Gamma Knife Radiosurgery. Stereotactic and Functional Neurosurgery. 2008;86(3):135-146. https://doi.org/10.1159/000120425
[23] Lambru G, Zakrzewska J, Matharu M. Trigeminal neuralgia: a practical guide. Practical Neurology. 2021;21(5):392-402. https://doi.org/10.1136/practneurol-2020-002782
[24] Bendtsen L, Zakrzewska JM, Abbott J, et al. European Academy of Neurology guideline on trigeminal neuralgia. European Journal of Neurology. 2019;26(6):831-849. https://doi.org/10.1111/ene.13950
[25] Leckband SG, Kelsoe JR, Dunnenberger HM, et al. Clinical Pharmacogenetics Implementation Consortium guidelines for HLA-B genotype and carbamazepine dosing. Clinical Pharmacology & Therapeutics. 2013;94(3):324-328. https://doi.org/10.1038/clpt.2013.103
[26] Zakrzewska JM, Chaudhry Z, Nurmikko TJ, Patton DW, Mullens LE. Lamotrigine (Lamictal) in refractory trigeminal neuralgia: results from a double-blind placebo controlled crossover trial. Pain. 1997;73(2):223-230. https://doi.org/10.1016/s0304-3959(97)00104-8
[27] Shaikh S, Yaacob HB, Rahman RBA. Lamotrigine for trigeminal neuralgia: Efficacy and safety in comparison with carbamazepine, Journal of the Chinese Medical Association. 2011;74(6):243-249. https://doi.org/10.1016/j.jcma.2011.04.002
[28] Silver M, Blum D, Grainger J, Hammer AE, Quessy S. Double-Blind, Placebo-Controlled Trial of Lamotrigine in Combination with Other Medications for Neuropathic Pain. Journal of Pain and Symptom Management. 2007;34(4):446-454. https://doi.org/10.1016/j.jpainsymman.2006.12.015
[29] Schnell S, Marrodan M, Acosta JN, Bonamico L, Goicochea MT. Trigeminal neuralgia crisis – intravenous phenytoin as acute rescue treatment. Headache the Journal of Head and Face Pain. 2020;60(10):2247-2253. https://doi.org/10.1111/head.13963
[30] Kolakowski L, Pohl H, Kleinsorge MT, Wegener S. Phenytoin relieves acute exacerbations of trigeminal neuralgia: Results of a retrospective case series. Cephalalgia Reports. 2024;7. https://doi.org/10.1177/25158163241268880
[31] Gronseth G, Cruccu G, Alksne J, et al. Practice Parameter: The diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review). Neurology. 2008;71(15):1183-1190. https://doi.org/10.1212/01.wnl.0000326598.83183.04
[32] Cruccu G, Gronseth G, Alksne J, et al. AAN‐EFNS guidelines on trigeminal neuralgia management. European Journal of Neurology. 2008;15(10):1013-1028. doi:10.1111/j.1468-1331.2008.02185.x
[33] Fromm GH, Terrence CF, Chattha AS. Baclofen in the treatment of trigeminal neuralgia: Double‐blind study and long‐term follow‐up. Annals of Neurology. 1984;15(3):240-244. https://doi.org/10.1002/ana.410150306
[34] Wiffen PJ, Derry S, Bell RF, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Library. 2017;2020(2). https://doi.org/10.1002/14651858.cd007938.pub4
[35] Kolakowski L, Pohl H, Stieglitz L, et al. Interdisciplinary strategies for diagnosis and treatment of trigeminal neuralgia. Schweizerische Medizinische Wochenschrift. 2024;154(7):3460. https://doi.org/10.57187/s.3460
[36] Tuleasca C, Régis J, Sahgal A, et al. Stereotactic radiosurgery for trigeminal neuralgia: a systematic review. Journal of Neurosurgery. 2018;130(3):733-757. https://doi.org/10.3171/2017.9.jns17545
[37] Wu CJ, Lian YJ, Zheng YK, et al. Botulinum toxin type A for the treatment of trigeminal neuralgia: results from a randomized, double-blind, placebo-controlled trial. Cephalalgia. 2012;32(6):443-450. https://doi.org/10.1177/0333102412441721
[38] Zhang H, Lian Y, Ma Y, et al. Two doses of botulinum toxin type A for the treatment of trigeminal neuralgia: observation of therapeutic effect from a randomized, double-blind, placebo-controlled trial. The Journal of Headache and Pain. 2014;15(1). https://doi.org/10.1186/1129-2377-15-65
[39] Lamsal R, Rath GP. Neuromodulation in trigeminal neuralgia. In: Springer eBooks. ; 2019:187-193. https://doi.org/10.1007/978-981-13-2333-1_24
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Copyright (c) 2026 Agata Pomirska, Bartosz Pomirski, Anna Wilewska, Julia Biernikiewicz, Konstanty Alabrudziński, Milena Biernikiewicz, Agnieszka Borowiec, Aleksandra Dach, Kinga Borowiec, Paulina Kwaśniewska

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