Department: Ask the Experts
Answers to your questions about neuropathy, trigeminal neuralgia, seizure meds and pregnancy, and migraine and heart disease.
Charles E. Argoff, M.D., is director of the Cohn Pain Management Center at the North Shore University Hospital in Long Island, NY and assistant professor of neurology at the New York University School of Medicine in New York City.
Q Are there drugs to control the unbearable pain of trigeminal neuralgia?
A Several different types of medications provide pain relief, although not all medications are equally effective or well tolerated. Most of the medications are also used for the treatment of epilepsy and are commonly referred to as anti-epileptic medications.
For more than 40 years, studies have shown that carbamazepine (Tegretol) may be effective at reducing the frequency and severity of painful episodes due to trigeminal neuralgia. The downside includes side effects such as bone marrow suppression and liver dysfunction, both of which require careful and ongoing monitoring.
Less rigorously studied has been oxcarbazepine (Trileptal). This medication may be just as good at carbamazepine at reducing the number of pain attacks, but the studies were not placebo-controlled and so it is more difficult to interpret the results. Another drug, lamotrigine, is effective for reducing pain when added to an already established medical regimen for trigeminal neuralgia. In addition, small studies have suggested that other anti-epileptic medications including gabapentin (Neurontin), clonazepam (Klonopin), and valproic acid may have some benefit.
The main thing is to consult with your neurologist to determine the best regimen for you.