The type of medications we prescribe depends on the cause of face pain, as different medical treatment options can be effective. Since some of these medications may have side effects during the course of treatment, regular follow-up and blood work may be necessary.
For classic trigeminal neuralgia, Carbamazepine and its family of drugs (e.g. Oxcarbazepine) is the gold standard treatment. Besides possible side effects, Carbamazepine is associated with dose-limiting side effects, particularly with prolonged usage. This is a major problem in the long-term treatment of classical trigeminal neuralgia. Therefore, we recommend “surgical consultation” and treatment (see below) sooner rather than later in this class of patients. Additionally, this class of medication can have drug interactions with some medications, which the patient might be taking and therefore physicians who prescribing these medication needs to be aware of drug-drug interaction.
When we start the patient on carbamazepine (Tegretol) or oxcarbazepine (Trileptal), we do regular blood work, since these medications can cause abnormalities in serum sodium levels, liver enzymes, and white blood cells, which could cause serious complications if not screen and diagnosed early.
Other medications, including Gabapentin (Neurontin) and Pregabalin (Lyrica) can be used as second line and can be partially effective. It is important to note that the dosage needed to control trigeminal pain is relatively high, which might cause adverse events, making these treatment options intolerable for the patient.
There are several other medications which have been tried and used in trigeminal neuralgia, however, none are backed by strong evidence and are unlikely to be effective.
Some patients with facial pain benefit from holistic therapeutic options, such as massage or acupuncture.
We strive to balance our treatments so that patients have access to different facets of medical care, including holistic treatment. We offer acupuncture services in our clinic for patients with facial pain.
Procedural treatments for face pain range from injections, such as peripheral nerve blocks (particularly inferior alveolar nerve), occipital nerve blocks, and sphenopalatine ganglion blocks, to Botox therapy.
These procedures can both be used as treatment options, and occasionally as diagnostic tools to help understand the precise origin of pain.
None of these treatment has been approved for classical trigeminal neuralgia. Therefore, insurance companies often do not approve these injection treatment. Since some of these procedure, particularly Botox are relatively expensive, these option have limited use in practice.