Pelvic Pain

Your doctor will usually prescribe medication to reduce or block the pain signals sent to your brain to treat trigeminal neuralgia.

Antiseizure medication: Trigeminal neuralgia is commonly treated with carbamazepine (Tegretol, Carbatrol, and other brands), which has proven effective for this condition. Other anticonvulsants like valproate, oxcarbazepine (Trileptal, Oxtellar XR), lamotrigine (Lamictal), and phenytoin (Dilantin, Phenytek, Cerebyx) may also be used. Additionally, medications such as gabapentin (Neurontin, Gralise, Horizant), pregabalin (Lyrica), topiramate (Qsymia, Topamax, and others), and clonazepam (Klonopin) might be prescribed. If the medication you’re taking becomes less effective, your doctor may adjust the type or dosage. Anticonvulsant side effects can include nausea, drowsiness, dizziness, and confusion. Genetic testing may be recommended before starting carbamazepine, especially for individuals of Asian descent, due to the risk of serious reactions.

Muscle relaxants: Baclofen (Gablofen, Lioresal, Ozobax) and other muscle relaxants may be prescribed alone or with carbamazepine. Possible side effects include drowsiness, nausea, and disorientation.

Botox injections: Injections of onabotulinumtoxinA (Botox) might help reduce pain in individuals for whom other medications are no longer effective. However, more research is needed before this treatment is widely adopted for trigeminal neuralgia.

• **Decompression of microvascular structures:** This procedure involves shifting or removing blood vessels that are in contact with the trigeminal nerve to prevent nerve dysfunction. During microvascular decompression, your doctor will make an incision behind the ear on the side of your pain. They will then create a soft cushion between the trigeminal nerve and any arteries by making a small incision in your head and repositioning or removing any arteries pressing on the nerve. If a vein is compressing the nerve, it may be removed. In some cases, a nervectomy may be performed if arteries are not the issue.

  Microvascular decompression can be an effective long-term pain management solution, but about 30% of patients may experience pain recurrence within 10 years. Possible side effects include stroke, hearing loss, facial paralysis, and facial numbness, although most patients do not experience facial numbness.

  **Gamma knife stereotactic radiosurgery:** This procedure involves targeting the trigeminal nerve root with a precise dose of radiation. The goal is to damage the nerve to reduce or eliminate pain. Pain relief typically occurs gradually over a period of up to one month.

  For most patients, stereotactic radiosurgery provides effective pain relief. However, like any surgical procedure, there is a risk of pain recurrence, usually within three to five years. If the pain returns, you may need to undergo the procedure again or consider alternative treatments. A common long-term side effect that may occur months or years after the treatment is facial numbness.