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Refractory Trigeminal Neuralgia

Non-Surgical Treatment Options

  • Therapy in Practice
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Abstract

The guidelines on trigeminal neuralgia management published by the American Academy of Neurology (AAN) and the European Federation of Neurological Societies (EFNS) recommended that patients unresponsive to carbamazepine or oxcarbazepine be offered the surgical option. However, because some patients may not be willing to resort to surgery, we searched the literature for treatment in refractory trigeminal neuralgia. We found other oral treatments, intranasal spray, subcutaneous injections, various kinds of peripheral nerve blocks and injections of botulinum toxin. On the basis of the available evidence we suggest that no oral treatment other than carbamazepine or oxcarbazepine is useful. Among the other options, there is increasingly strong evidence that botulinum toxin injections are efficacious and may be offered before surgery or to those unwilling to undergo surgery.

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Acknowledgments

The authors declare that their work was by no means influenced by their relationships with drug companies. Nevertheless, the authors wish to declare that they received honoraria for participation in advisory boards or for giving lectures at sponsored symposia from the following drug companies: Astellas, Lilly and Pfizer.

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Authors and Affiliations

  1. Department of Neurology and Psychiatry, Sapienza University, Viale Università 30, 00185, Rome, Italy

    Giorgio Cruccu & Andrea Truini

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  1. Giorgio Cruccu
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  2. Andrea Truini
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Correspondence to Giorgio Cruccu.

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Cruccu, G., Truini, A. Refractory Trigeminal Neuralgia. CNS Drugs 27, 91–96 (2013). https://doi.org/10.1007/s40263-012-0023-0

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