Trigeminal Neuralgia Medication Not Working? What to Do Next

Trigeminal neuralgia comes down to one thing: pain. That’s why it can be difficult when your trigeminal neuralgia medication is not working. However, there are other treatment options available, and though medication is typically the first method your doctor will recommend, some patients will require other interventions to provide relief.

While a conversation with your doctor is necessary, it can be helpful to have a more thorough understanding of your condition, why your trigeminal neuralgia medication is not working and what other treatment options may be available to you. This will empower you in your conversation and help you take a more active role in managing your condition as you move into the next phase of your treatment.

About Trigeminal Neuralgia

Trigeminal neuralgia is a chronic pain condition that affects areas of the head and face. Patients who suffer from trigeminal neuralgia experience recurring bouts of severe pain, which can become debilitating if left untreated. The ultimate source of pain is the trigeminal nerve, which transmits sensations (including touch and pain) from the head, face and neck to the brain. However, sometimes the nerve becomes overactive, leading to pain without stimulation.

Anyone can be affected by trigeminal neuralgia, but it most commonly affects women over 50. Sometimes the cause is unknown, but it is often because of pressure on the trigeminal nerve, typically from a blood vessel, causing it to be stimulated and triggering pain. It can also be related to systemic conditions, such as multiple sclerosis.

Trigeminal neuralgia has been an elusive condition to treat until somewhat recently. Because no conclusive diagnostic tests or images can be done, diagnosis is made entirely based on a patient’s symptoms, making it relatively difficult to diagnose and understand. However, through research and clinical experience, the medical field has developed new treatment methods, such as Gamma Knife radiosurgery.

Why Your Medication Is Not Working

There are a few different types of medications used to treat trigeminal neuralgia. Some help ease the pain directly, while others try to provide relief by eliminating the cause of the dysfunction. Sometimes the nerve is overstimulated, and medications can help inhibit it from firing excessively and causing pain. Anti-seizure medications and some antidepressants can help in this fashion and are typically the first step your doctor takes in treating your trigeminal neuralgia.

However, sometimes your trigeminal neuralgia medication does not work. This may happen because your condition is a result of something physically pressing on the nerve and causing it to fire inappropriately. Sometimes a tumor is causing the pressure, but it is most commonly a blood vessel near the brain that is the culprit. When this is the case, further intervention to remove the impingement may be necessary in order to provide relief.

Your Next Steps

If you feel like your trigeminal neuralgia medication is not working, it is important you schedule an appointment with your doctor immediately. Your doctor will discuss your symptoms and whether you have received any relief from your medications, which ones and to what degree. Sometimes imaging may be necessary to help your doctor determine the next appropriate steps. It is important you are working with someone experienced in treating your condition, such as a neurologist, as you move into your next phase of treatment.

Gamma Knife for Trigeminal Neuralgia

Should your doctor determine there is a structure putting pressure on the trigeminal nerve, different treatment options are available, including traditional surgery. However, there is a minimally invasive approach that requires no hospital stay, no incisions and reduced healing time: Gamma Knife radiosurgery.

Despite its name, Gamma Knife is not a surgical procedure, but is instead an advanced form of radiation therapy. By using multiple, highly focused radiation beams, your doctor is able to target only the area to be treated, sparing healthy surrounding tissues. As a result, patients experience fewer unpleasant side effects commonly associated with radiation therapy and can be treated in fewer sessions.

Gamma Knife radiosurgery is performed in an outpatient setting, often in a hospital but not requiring a stay longer than a couple of hours beyond treatment completion. The length of your treatment session depends on the location and size of the area being treated but tends to last from 15 minutes to a little over an hour. Many patients require only a single session of treatment, but this too depends on your individual condition.

Keep Looking for Answers

If your trigeminal neuralgia medication is not working, you do not have to continue to live with the pain. There are other treatment options available, and your doctor will work with you to determine the next steps in treating your individual condition. No two patients are exactly alike, and what works for one person is not necessarily going to be the right solution for you.

Self-education is a fantastic way to play an active role in your health, and learning as much as you can about your condition and treatment options will allow you to better understand your condition. Take the information you have learned into your next conversation with your doctor and ask about Gamma Knife radiosurgery for treating trigeminal neuralgia.

Anthony D’Ambrosio, M.D., M.B.A., F.A.A.N.S
Anthony D’Ambrosio, M.D., M.B.A., F.A.A.N.S
Dr. Anthony D’Ambrosio is a board-certified neurosurgeon that specializes in Neurosurgery, Stereotactic Radiosurgery, Gamma Knife Radiosurgery (GKRS) and more. He is the Director of Neurosurgery and Co-Director of the Gamma Knife Program at The Valley Hospital. Dr. D’Ambrosio is an expert in treating patients with trigeminal neuralgia, benign or malignant brain tumors, as well as many other neurological conditions.

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