Botox for trigeminal neuralgia

Botox injections relieve pain of trigeminal neuralgia, according to a new study just published in Cephalalgia, a leading headache journal. Trigeminal neuralgia is an extremely painful condition which manifests itself by intense electric shock-like pain on one side of the face. The pain is triggered by speaking, chewing and often without any provocation. Persistent pain can lead to malnutrition from the inability to chew and to severe depression and despondency. Epilepsy drugs, such as carbamazepine (Tegretol), oxcarbazepine (Trileptal), and other types of drugs often relieve the pain, but not always and at times the drugs can cause intolerable side effects.
Research on the mechanism of action of Botox has shown that it may be blocking sensory nerves and this led me to try Botox for a few of my patients with conditions other than chronic migraines and other headaches. Several patients with post-herpetic neuralgia (shingles) and a few with trigeminal neuralgia responded very well.
This rigorous double-blind, placebo-controlled study in Cephalalgia by Chinese researchers involved 42 patents with trigeminal neuralgia, of whom 40 completed the study. Among the patients who received Botox injections, 68% had significant improvement compared to only 15% of responders in the group tht received placebo. This study strongly suggests that Botox is an effective treatment for some patients with trigeminal neuralgia. The advantage of Botox is that it has significantly fewer side effects than oral drugs.

  1. Millie says: 12/25/20129:12 pm

    I am a 78 year old woman with tn what would you recommend to relieve pain? Would you recommend mvp? Do you know a surgeon in MO? My family is insisting I look into botox. What are your thoughts?
    Thank you,

  2. Dr. Mauskop says: 12/25/20129:31 pm

    I cannot make any specific recommendations since I don’t know you or the particulars of your case, but in general it is reasonable to try Botox injections before considering surgical treatment since Botox is so much safer. I assume that your neurologist has already prescribed drugs such as Tegretol (carabamazepine) or Trileptal (oxcarbazepine), Dilantin (phenytoin), baclofen, and other. If not, you may want to try those first.

  3. Catherine says: 01/06/201312:19 am

    My TGN is kept at bay with botox. My doctor prescribed different medications to deal with the nerve pain. These were not successful. He then prescribed Oxycotin which at least would let me sleep. Finally my local doctor did the Botox shot and told me it should last about six months. It typically lasted about eight. The last shot I had was about two years ago and its only been in the last couple of months that it has been creeping back. The local doctor left so now I have to wait for a referral to a new doctor who will administer the botox. I do not take any other medication for my condition and wish I could share with more people my results!

  4. Paulene says: 01/08/20139:57 pm

    Hello Doctor Mauskop,

    I live in Ontario Canada. Do you know of any doctors that perform this near Oshawa, Ontario or even Toronto? I have had ATN since September of 2006 and have had gamma knife surgery with Dr. Hodai. It was unsuccessful. I am too scared to have an MVD as Dr. Timyanski told me that that I am not a good candidate for the surgery and there is only 60% success rate. He also said there are things worse than death with an MVD and that was enough for me to hear to avoid it. I have left sided ATN with burning and shocks in all three branches. Would Botox be something that may help? Even if the burning could be lessened I would be happy. I can be reached at my email address if you have names of doctors in my area. Thanks so much.

  5. Dr. Mauskop says: 01/10/201311:30 pm

    I have trained several Toronto neurologists in treating migraines with Botox, but I don’t know if they would inject it for neuralgia. Trying contacting Drs. Christina Lay at University of Toronto, Dr. Ian Finkelstein or Dr. Marek Gawel.

  6. Laureen says: 03/28/20137:45 pm

    Dr. Mauskop,
    Do you know of any doctors that perform this near San Francisco or the West Coast? I am searching for someone for my dad who has been suffering for years and now can not take codeine anymore. If not are you taking patients?
    Thank you.

  7. Dr. Mauskop says: 03/28/20139:33 pm

    You may want to check with the manufacturer, Allergan, who has a website that lists the names of doctors who are trained to inject Botox for chronic migraines. Call these doctors to see if any of them have experience injecting Botox for trigeminal neuralgia.

  8. Adam West says: 04/05/20138:15 am

    Hello Dr. Mauskop.
    I am a 43 year old Australian male, that has slowly progressive ‘idiopathic trigeminal neuropathy’ – 2nd and 3rd branches, right side. I know this condition is minor compared to others with severe trigeminal disorders, but it is slowly taking toll on my life and family.
    I have been trying to discuss the idea of Botox injections to relieve my pain and aching, with various Australian Neuro specialists, but they all dismiss the idea.
    Have you heard of Botox being used to treat Trigeminal Neuropathy (constant, chronic symptoms) and do you have any contacts within Australia that may be receptive to the Botox idea?
    Thanks for your time!

  9. Dr. Mauskop says: 04/05/20138:29 pm

    I would suggest contacting Dr. Christina Sun-Edelstein, who worked at the New York Headache Center and now lives and works in Melbourne. She injects Botox for chronic migraine headaches and it is possible that she may be able to give Botox for your trigeminal neuropathy.

  10. Agnes Wood says: 03/29/20145:31 pm

    Thank you for taking the time to share about your experiences with TN patients and botox. I have had TN and nerve damage for 23 years and have been treated with Trileptal and Amitriptyline for 20 years with fair results. I am not a candidate for a MVD because of the nerve damage. Breakthrough pain persists and has progressed dramatically over the years. My neurologist has suggested botox treatments, and although he has many migraine patients he is treating with botox, he has not yet injected anyone for TN. As such, he does not know how to perform the procedure for a TN patient. He needs to know where the injects should be located and the amount of botox that is necessary for one treatment. Could I have my neurologist contact you via email to discuss the procedure with you?

  11. Dr. Mauskop says: 03/29/20146:25 pm

    No problem – have your neurologist call. Botox injections for trigeminal neuralgia is even simpler than for migraines.

  12. ken says: 05/19/20144:19 pm

    I am a 50 year old male with tn I have been tormented with this issue from 2007 I have tried it all pretty much all suggested meds from neurologist and I mean all, gamma knife is the key to this issue I swear by it night and day difference it works not micro vasculare decompression surgery witch is more complex it worked

  13. Sam says: 09/24/20146:56 am

    Hi Adam, I also have ATN. If you live in Sydney try Dr Stephen Tisch at St Vincents Hospital (Public), Darlinghurst. I had my first botox injection today and am yet to see if it is successful. Best of luck

  14. Julia says: 11/19/20145:55 pm

    Which muscles did you inject with good effect. I have trigeminal neuropathy, my doctor injected masseter, but he says if he injects other muscles, it’ll droop my face. What muscles can you inject?

  15. Dr. Mauskop says: 11/19/20147:47 pm

    I usually inject Botox superficially into the skin over the painful area rather than into the muscles, which minimizes (but does not eliminate) the chance of “drooping”. The effect of Botox on pain and chronic migraines is thought to be due to blocking of the nerve endings rather than relaxing muscles.

  16. Julia S says: 12/06/20143:53 pm

    I received botox injections all over my face, and they did absolutely NOTHING to my trigeminal neuropathy.

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