Editing Trigeminal neuralgia (section)

==Management==
There is evidence that points towards the need to quickly treat and diagnose TN. It is thought that the longer a patient has TN, the harder it may be to reverse the neural pathways associated with the pain.{{citation needed|date=August 2021}}

===Medical===
* The [[anticonvulsant]] [[carbamazepine]] is the first line treatment; second line medications include [[baclofen]], [[lamotrigine]], [[oxcarbazepine]], [[phenytoin]], [[topiramate]], [[gabapentin]] and [[pregabalin]]. Uncontrolled trials have suggested that [[clonazepam]] and [[lidocaine]] may be effective.<ref name=Sindrup2002>{{cite journal | vauthors = Sindrup SH, Jensen TS | title = Pharmacotherapy of trigeminal neuralgia | journal = The Clinical Journal of Pain | volume = 18 | issue = 1 | pages = 22–27 | year = 2002 | pmid = 11803299 | doi = 10.1097/00002508-200201000-00004 | s2cid = 24407923 }}</ref>
* Antidepressant medications, such as [[amitriptyline]] have shown good efficacy in treating trigeminal neuralgia, especially if combined with an anti-convulsant drug such as pregabalin.<ref>{{cite journal| vauthors = Ahmed OL, Akinyele OA, Akindayo OA, Bamidele K |title=Management of Trigeminal Neuralgia using Amitriptyline and Pregablin combination Therapy|url=http://www.bioline.org.br/pdf?md12033|journal=African Journal of Biomedical Research|date=September 2012|volume=15|number=1|pages=201–203|display-authors=etal|url-status=live|archive-url=https://web.archive.org/web/20160822053222/http://www.bioline.org.br/pdf?md12033|archive-date=2016-08-22}}</ref>
* There is some evidence that [[duloxetine]] can also be used in some cases of neuropathic pain, especially in patients with major depressive disorder<ref>{{cite journal | vauthors = Hsu CC, Chang CW, Peng CH, Liang CS | title = Rapid Management of Trigeminal Neuralgia and Comorbid Major Depressive Disorder With Duloxetine | journal = The Annals of Pharmacotherapy | volume = 48 | issue = 8 | pages = 1090–1092 | date = August 2014 | pmid = 24788987 | doi = 10.1177/1060028014532789 | s2cid = 38592913 }}</ref> as it is an antidepressant. However, it should, by no means, be considered a first line therapy and should only be tried by specialist advice.<ref>{{cite journal | vauthors = Lunn MP, Hughes RA, Wiffen PJ | title = Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 1 | pages = CD007115 | date = January 2014 | pmid = 24385423 | pmc = 10711341 | doi = 10.1002/14651858.CD007115.pub3 }}</ref>
* There is controversy around opiate use such as [[morphine]] and [[oxycodone]] for treatment of TN, with varying evidence on its effectiveness for neuropathic pain. Generally, opioids are considered ineffective against TN and thus should not be prescribed.<ref>{{cite journal | vauthors = Zakrzewska JM, Linskey ME | title = Trigeminal neuralgia | journal = BMJ | volume = 348 | issue = feb17 9 | pages = g474 | date = February 2014 | pmid = 24534115 | doi = 10.1136/bmj.g474 | url = http://www.bmj.com/bmj/section-pdf/752707?path=/bmj/348/7946/Clinical_Review.full.pdf | url-status = live | s2cid = 45305211 | archive-url = https://web.archive.org/web/20161220132327/http://www.bmj.com/bmj/section-pdf/752707?path=%2Fbmj%2F348%2F7946%2FClinical_Review.full.pdf | archive-date = 20 December 2016 }}</ref>

===Surgical===
[[Microvascular decompression]] provides freedom from pain in about 75% of patients presenting with drug-resistant trigeminal neuralgia.<ref>{{cite journal | vauthors = Holste K, Chan AY, Rolston JD, Englot DJ | title = Pain Outcomes Following Microvascular Decompression for Drug-Resistant Trigeminal Neuralgia: A Systematic Review and Meta-Analysis | journal = Neurosurgery | volume = 86 | issue = 2 | pages = 182–190 | date = February 2020 | pmid = 30892607 | pmc = 8253302 | doi = 10.1093/neuros/nyz075 }}</ref><ref name=Surgery11>{{cite journal | vauthors = Zakrzewska JM, Akram H | title = Neurosurgical interventions for the treatment of classical trigeminal neuralgia | journal = The Cochrane Database of Systematic Reviews | volume = 2011 | issue = 9 | pages = CD007312 | date = September 2011 | pmid = 21901707 | pmc = 8981212 | doi = 10.1002/14651858.CD007312.pub2 }}</ref><ref>{{cite web | vauthors = Barbor M | date = 5 October 2015 | title = MVD Bests Gamma Knife for Pain in Trigeminal Neuralgia | url = http://www.medscape.com/viewarticle/852161 | archive-url = https://web.archive.org/web/20151110112736/http://www.medscape.com/viewarticle/852161 | archive-date=2015-11-10 }}</ref> While there may be pain relief after surgery, there is also a risk of adverse effects, such as facial numbness. Percutaneous radiofrequency thermorhizotomy may also be effective<ref name="Sindou 203–10">{{cite journal | vauthors = Sindou M, Tatli M | title = [Treatment of trigeminal neuralgia with thermorhizotomy] | journal = Neuro-Chirurgie | volume = 55 | issue = 2 | pages = 203–210 | date = April 2009 | pmid = 19303114 | doi = 10.1016/j.neuchi.2009.01.015 }}</ref> as may [[stereotactic surgery|stereotactic radiosurgery]]; however the effectiveness decreases with time.<ref>{{cite journal | vauthors = Dhople AA, Adams JR, Maggio WW, Naqvi SA, Regine WF, Kwok Y | title = Long-term outcomes of Gamma Knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. Clinical article | journal = Journal of Neurosurgery | volume = 111 | issue = 2 | pages = 351–358 | date = August 2009 | pmid = 19326987 | doi = 10.3171/2009.2.JNS08977 }}</ref>

Surgical procedures can be separated into non-destructive and destructive:

====Non-destructive====
* Microvascular decompression – this involves a small incision behind the ear and some bone removal from the area. An incision through the [[meninges]] is made to expose the nerve. Any vascular compressions of the nerve are carefully moved and a sponge-like pad is placed between the compression and nerve, stopping unwanted pulsation and allowing myelin sheath healing.{{citation needed|date=September 2020}}

====Destructive====
All destructive procedures will cause facial numbness, post relief, as well as pain relief.<ref name="Surgery11"/>
* Percutaneous techniques which all involve a needle or catheter entering the face up to the origin where the nerve splits into three divisions and then damaging this area, purposely, to produce numbness but also stop pain signals. These techniques are proven effective<ref name="Sindou 203–10"/> especially in those where other interventions have failed or in those who are medically unfit for surgery such as the elderly.
* Balloon compression – inflation of a balloon at this point causing damage and stopping pain signals.
* [[Glycerol]] injection – deposition of a corrosive liquid called glycerol at this point causes damage to the nerve to hinder pain signals.
* Radiofrequency thermocoagulation [[rhizotomy]] – application of a heated needle to damage the nerve at this point.
* [[Stereotactic radiosurgery]] is a form of radiation therapy that focuses high-power energy on a small area of the body.<ref>{{cite web| vauthors = Yi-Bin C |title=Stereotactic radiosurgery – Cyber Knife|url=https://www.nlm.nih.gov/medlineplus/ency/article/007274.htm|website=MedLine Plus|access-date=20 November 2015|url-status=live|archive-url=https://web.archive.org/web/20151121045317/https://www.nlm.nih.gov/medlineplus/ency/article/007274.htm|archive-date=21 November 2015}}</ref>

===Support===
Psychological and social support has found to play a key role in the management of chronic illnesses and chronic pain conditions, such as trigeminal neuralgia. Chronic pain can cause constant frustration to an individual as well as to those around them.<ref>{{cite web| vauthors = Molitor N |title=Dr|url=http://www.apa.org/helpcenter/chronic-pain.aspx |publisher=American Psychological Association|access-date=27 June 2015|url-status=live|archive-url=https://web.archive.org/web/20150626215241/http://www.apa.org/helpcenter/chronic-pain.aspx|archive-date=26 June 2015}}</ref>