Structured Medical Management Improves Trigeminal Neuralgia Outcomes

Artwork illustrating trigeminal neuralgia, showing nerves (yellow) and muscle (red) in a woman’s face. Trigeminal neuralgia (also called tic douloureux) is a severe burning or stabbing pain that affects the branches of the trigeminal nerve, the fifth and largest of the cranial nerves. The trigeminal nerve is split into three divisions: theophthalmic (eyes), maxillary (facial) and mandibular (jaw) nerves. Branches of the maxillary nerve to the cheek are the main features in this illustration.
A structured medical management program was found to improve outcomes in patients with trigeminal neuralgia after 2 years.

A structured medical management program was found to improve outcomes in patients with trigeminal neuralgia after 2 years, according to a study published in The Journal of Headache and Pain.

The study included participants enrolled in a structured management program at a specialist center for facial pain (n=186). The program consisted of optimization of medical treatment, physiotherapy, psychotherapy, and advice from trained nurses. Medically intractable participants were referred for neurosurgery.

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Data were prospectively collected using standardized schemes and patient surveys. The primary outcome was a 50% reduction in the overall burden of pain assessed with a 0 to 10 numeric rating scale (NRS) 2 years after enrollment in the program.

Of 186 enrolled participants, 103 completed the 2-year follow-up. Of these, 50 patients were treated surgically during the follow-up period.

The mean burden of pain decreased from 5.34 to 3.00 (P <.01). Over the 2-year period, 51% (n=53) of participants who were medically managed reported >50% reduction in the overall burden of pain. At the 2-year follow-up vs baseline, more participants reported no overall burden of pain (ie, NRS score of 0; 16 vs 2 patients, respectively; P <.002) and mild burden of pain (ie, NRS score of 1-4; 63 vs 38 patients, respectively; P =.002).

No association was established between the primary outcome and sex, depression and/or anxiety, concomitant persistent pain, or neurovascular contact with morphologic changes in the trigeminal nerve.

“Findings indicate that [trigeminal neuralgia] is not an invariably progressive disease and provides optimism and hope to clinicians and patients that medical treatment of [trigeminal neuralgia] by experts is highly rewarding,” the researchers noted.


Heinskou TB, Maarbjerg S, Wolfram F, et al. Favourable prognosis of trigeminal neuralgia when enrolled in a multidisciplinary management program – a two-year prospective real-life study [published online March 4, 2019]. J Headache Pain. doi:10.1186/s10194-019-0973-4

This article originally appeared on Clinical Pain Advisor