The somewhat motley spectrum of various procedures for neuromodulation therapy of facial pain was reviewed in a recent study. The techniques included were transcranial direct current stimulation, repetitive transcranial magnetic stimulation, motor cortex stimulation, deep brain stimulation and spinal cord stimulation. Most studies showed improvement in Numeric Rating Scale for pain, usually btween 20 and 60%. The heterogeneity with regard to research design precluded direct c

Electrical stimulation of the trigeminal ganglion (ganglion Gasseri) for refractory trigeminal pain is a rare treatment option that may be efficient in selected cases. The efficacy and safety of electrical stimulation was studied in a recent literature review. Some pain relief was seen in 78,7% of cases while 21,3% showed no improvement. Complications were seen in 39%, mainly involving minor issues. The authors conclude that the technique may be beneficial in some cases but t

The development of new drugs that may be of value in the treatment of trigeminal neuralgia is reviewed in a recent article emanating from the Mayo Clinic. Of primary interest are lacosamide and eslicarbazepine. One study found that 66% of patients who had failed first-line medical therapies had improvement on lacosamide with 34% reporting complete pain relief. Adverse effects were dizziness, sleepiness and instability. Eslicarbazepine, a cousin to carbamazepine and oxcarbaze

The longterm outcome of repeat MVD vs balloon compression after recurrence of pain after MVD was studied in 248 patients. 127 were treated with repeat MVD and 121 with balloon compression. The results were similar after follow-up times up to 15 years. As expected, problems with numbness in the cheek were more common in the balloon compression group whereas hearing loss and wound complications were seen in the MVD group. The authors conclude that the comparable efficacy of the

Another meta-analysis of botulinum toxin type A as monotherapy for neuralgic pain was recently published. It showed meaningful pain relief and functional improvement on patients with refractory neuralgic pain. Low-dose regimens were as efficient as higher doses. The authors conclude that large scale RCTs with standardized dosing and longer follow up are warranted to optimize treatment protocols. Personally, I have been skeptical to botox in TN therapy but it seems as I need t

A systematic review of effects of hyperbaric oxygen therapy (HBOT) on various pain syndromes was recently published. The results were somewhat depressing. The authors found little, if any, consistent improvement from HBOT on most pain syndromes, including trigeminal neuralgia.     J Pain Res 2026 Mar 24:19:597243. doi: 10.2147/JPR.S597243.   eCollection 2026.

Just read an interesting article about the prevalence of neuro-vascular contacts and neuro-vascular conflicts on the trigeminal nerve root in the asymptomatic, normal population. In 105 asymptomatic people (who made a Fiesta MRI for some other reason than trigeminal neuralgia) neuro-vascular contacts were found in 64. In these 64 cases a true conflict (compression or displacement) was found in 10. The prevalence of trigeminal neuralgia is estimated to about 1 in 2000 meaning

A recent retrospective study from Italy comprising 148 patients showed that the results of stereotactic radiosurgery for trigeminal neuralgia was not affected by the presence or absence of a neuro-vascular conflict. Sensory disturbances were predictive of long-term pain relief. Stereotact Funct Neurosurg. 2026 Mar 23:1-20. doi: 10.1159/000551200.Online ahead of print.

A recent meta-study shows that MVD and balloon compression have very similar both short-term and long-term results. MVD has a tendency to lower risk of recurrence. Complication rates are also similar. https://www.researchgate.net/publication/398630195_Microvascular_decompression_versus_percutaneous_balloon_compression_for_trigeminal_neuralgia_a_systematic_review_and_meta-analysis_of_double-arm_studies

A new British study shows that postoperative numbness after MVD surgery is an indication of of good long-term outcome. This suggests that manipulation of the nerve during surgery is part of the success. Also with the percutaneous procedures (balloon compression, radiofrequency lesion, glycerol blockade) postoperative numbness is more or less mandatory for long-time success.