Trigeminal Neuralgia Medications for Pain: What to Expect

For most patients in northern NJ, the first line of treatment for trigeminal neuralgia is prescription medications designed to help ease the pain. However, these medications may not be what you expect. Wherever you are in your diagnosis and treatment process, the following information is designed to help you better understand trigeminal neuralgia medications for pain, how they work and what you can do if they do not work for you.

What Causes Trigeminal Neuralgia?

Before discussing methods of treating trigeminal neuralgia, it can be helpful to understand its cause and why you experience the pain that you do. The trigeminal nerve is the cranial nerve that carries sensory information from the face to your brain, including pain. For a patient with trigeminal neuralgia, something causes the trigeminal nerve to fire off pain signals in response to things that should not be painful, such as smiling or eating.

Doctors now know that the cause of the trigeminal nerve misfiring is something pressing against it that should not be. The impingement is most commonly caused by a blood vessel of the brain, though it can also be a tumor or, rarely, another cause. This pressure causes the trigeminal nerve to send signals of pain, which can often be excruciating and debilitating. Thankfully, there are now treatment options available to help ease the pain.

What are the Trigeminal Neuralgia Medications for Pain?

Generally speaking, there are three classes of trigeminal neuralgia medications for pain. You may be surprised to learn that none of them are painkillers but are instead used to prevent the onset of attacks. Your doctor may prescribe you a single medication or may utilize a combination approach, depending on your individual condition and what your body responds to.


The first class of drugs is anticonvulsants. These are medications designed to prevent seizures by limiting the nerve’s ability to send signals, including the pain signals from the trigeminal nerve. These medications include:

  • Carbamazepine (Tegretol)
  • Gabapentin (Neurontin)
  • Lamotrigine (Lamictal)
  • Phenytoin (Dilantin)
  • Topiramate (Topamax)
  • Oxcarbazepine (Trileptal)

Carbamazepine is the most commonly prescribed medication in this class. However, efficacy declines over time for many patients, necessitating another form of treatment.

Muscle Relaxers

The second class of drugs, muscle relaxers, are often used in combination with anticonvulsants. Baclofen (Lioresal, Gablofen) is the typical prescription, and it also helps depress the transmission of signals from the nerve to the brain. However, Baclofen also decreases in effectiveness in the majority of patients over time, again leading to the need for alternative treatment options.


The final class of drugs your doctor may prescribe are tricyclic antidepressants, which help to block pain transmission. You may be prescribed amitriptyline, which can have a sedative effect and is only effective in certain trigeminal neuralgia patients. However, because it may be effective for you, your doctor may consider this prescription if you are not responding to other medications.

What If Medications Don’t Help?

While the first course of treatment is nearly always trigeminal neuralgia medications for pain, they may not ease your symptoms or their effectiveness may diminish with time. However, there are treatment options available that provide relief by treating the source of the problem, the impingement of your trigeminal nerve.

One treatment available in the tri-state area is Gamma Knife radiosurgery, a minimally invasive, non-surgical option that takes place in an outpatient setting. Gamma Knife radiosurgery is an advanced form of radiation therapy that uses 192 low-dose beams of radiation to target a very precise area. This means the specialist can use Gamma Knife radiosurgery to treat just the structure that is putting pressure on your trigeminal nerve, removing the impingement and stopping the very cause of your pain. That’s why Gamma Knife radiosurgery can provide relief even when medications have failed.

Even if your medications did provide pain relief but your symptoms returned over time, Gamma Knife radiosurgery is a possible treatment option. It takes place in a treatment center and does not require a hospital stay, and most patients are able to return to work and other normal activities within a day or so. Gamma Knife radiosurgery requires only a single treatment session when treating trigeminal neuralgia.

The Treatment You Need to Stop Your Pain

Because every patient is different, your doctor will recommend the trigeminal neuralgia treatment most appropriate for your individual situation. The first step will nearly always be trying different types of trigeminal neuralgia medication for pain. Sometimes these work great and provide relief from your symptoms, but understand that the relief can lessen over time based on how the drugs work within the body. However, try and remain patient and work with your doctor through the process, which can sometimes involve a degree of trial and error.

That said, if you find that your trigeminal neuralgia medications for pain are not working for you, there is hope. There are excellent treatment options available in NJ, such as Gamma Knife radiosurgery, that can treat the source of your trigeminal neuralgia, hopefully ending your pain once and for all.

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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