Recent advances in understanding/managing trigeminal neuralgia

F1000Res. 2019 Apr 17:8:F1000 Faculty Rev-505. doi: 10.12688/f1000research.16092.1. eCollection 2019.


Despite recent advances in understanding and treating trigeminal neuralgia, its management remains a considerable challenge. Better classification of different types of facial pain and the identification of prognostic factors for different treatment options lead the way toward better quality of life for the individual patient. Although the principles of treating trigeminal neuralgia remain basically the same, antiepileptic drugs, muscle relaxants, and neuroleptic agents are widely used medical treatment options. They were not originally developed for treating trigeminal neuralgia. Carbamazepine was studied in adequate placebo-controlled clinical trials in the 1960s and is still considered the most effective drug. Among emerging treatment options currently under clinical investigation are local botulinum neurotoxin type A injections and a novel sodium channel blocker (CNV1014802) that selectively blocks the Na v1.7 sodium channel. Non-pharmacological treatment options are non-invasive electrical stimulation with either transcranial direct-current stimulation or repetitive transcranial magnetic stimulation which both require further evaluation in regard to applicability. Surgical options remain a valid choice for patients not responding to medical treatment and include Gasserian ganglion percutaneous techniques, gamma knife surgery, and microvascular decompression. There is continual effort to improve these techniques and predict the outcome for better patient selection.

Keywords: facial pain; future treatment; pathophysiology; recent advances; treatment options; trigeminal neuralgia.

Publication types

  • Review

MeSH terms

  • Carbamazepine / therapeutic use
  • Humans
  • Phenyl Ethers / therapeutic use
  • Proline / analogs & derivatives
  • Proline / therapeutic use
  • Quality of Life
  • Radiosurgery*
  • Sodium Channel Blockers / therapeutic use
  • Transcranial Direct Current Stimulation*
  • Trigeminal Neuralgia / drug therapy
  • Trigeminal Neuralgia / therapy*


  • Phenyl Ethers
  • Sodium Channel Blockers
  • Carbamazepine
  • Proline
  • vixotrigine

Grants and funding

The author(s) declared that no grants were involved in supporting this work.