Facial Pain Medication – There’s No One Size Fits All

Trigeminal neuralgia and other facial pain conditions are so difficult to deal with and finding the right medication is far from easy.

Facial pain affects people differently. Some people get lightning bolts shooting through one side of their face. Other people might have stabbing or constant burning pain. Some have trigeminal neuralgia, others might have atypical facial pain, anaesthesia dolorosa or even facial migraines. And some people suffer from several types of facial pain.

Click here to learn about types of facial pain

Facial Pain Medication Works Differently For Everyone

Just like facial pain, the medication used to treat it affects people differently. Some people might get pain relief from a low dose of the first medication a doctor prescribes. But other people spend years trying to find something to help. Some people might get terrible side effects from one type of medication. But someone else can take that same medication and have no side effects at all.

There is simply no one size fits all when it comes to medication for facial pain.

The Most Common Type of Medication For Facial Pain

The most common type of medication for facial pain (especially classic trigeminal neuralgia) is an anticonvulsant. Anticonvulsants do help lots of people but they don’t help everyone.

But anticonvulsants aren’t the only drugs that can help trigeminal neuralgia. Other types of drugs such as antidepressants and muscle relaxants can also help.

Sometimes one medication can help on its own but, very often, a combination of meds can help more.

It is important to remember that everyone is different. Side effects can be different and the effectiveness can be different. Don’t put off trying a medication based on someone else’s experience.

Types of Medication That Can Help Trigeminal Neuralgia and Other Facial Pain

This post will let you know which medication can help, however, only your doctor can decide which to prescribe. They know you, know any other health issues you have and they know about other medication you take.

Always tell your doctor about any supplements or herbal products you take as some can interact with medication

Anticonvulsants

Anticonvulsants are the first-line treatment for trigeminal neuralgia. They alter the signal that the trigeminal nerve sends to the brain. You need to take them regularly to try to prevent those signals. A doctor should tell you how to take them, but most anticonvulsants need to be started at a very low dose then increased slowly. It can be dangerous to do otherwise.

Unfortunately, it can take time to get to a therapeutic dose. And the therapeutic dose is different for everyone. Many of these medications have a slow or extended release version which can often be more beneficial.

Examples:

Carbamazepine (Tegretol)

Oxcarbazepine (Trileptal)

Gabapentin (Neurontin)

Pregabalin (Lyrica)

Phenytoin (Dilantin)

Topiramate (Topamax)

Lamotrigine (Lamictal)

Levetiracetam (Keppra)

Valproate (Depakote)

Antidepressants

Some antidepressants can also help trigeminal neuralgia and other facial pain conditions (especially if the pain is constant, aching and burning.)

Most helpful are tricyclic antidepressants, however, some other antidepressants can also help. Antidepressants are not helping because of the antidepressant qualities. They actually affect the chemicals in our brains related to chronic pain.

For treating facial pain, antidepressants are often combined with another medication, normally an anticonvulsant.

Examples:

Amitriptyline (Elaviv) – Tricyclic antidepressant

Nortriptyline (Pamelor) – Tricyclic antidepressant

Imipramine (Norfranil, Tofranil) – Tricyclic antidepressant

Venlafaxine (Effexor) – Serotonin norepinephrine reuptake inhibitors (SNRIs)

Duloxetine (Cymbalta) – Serotonin norepinephrine reuptake inhibitors (SNRIs)

Muscle Relaxants & Tranquilizers

These can also be helpful. Like antidepressants, doctors normally prescribe them as an add-on alongside an anticonvulsant.

Examples:

Baclofen (Lioresal) – Muscle relaxant

Tizanidine (Zanaflex) – Muscle Relaxant

Clonazepam (Klonopin) – Tranquilizer

Triptan Migraine Medication

Triptans are a class of medication which can help relieve the pain of migraines and cluster headaches. Some people suffer from facial migraines so, in that case, a migraine medication could help. Even if you haven’t been diagnosed with facial migraines, it might be worthwhile asking your doctor if you could try a triptan medication during a bad flare. It might help, it might not…but without trying, you’ll never know.

Examples:

Sumatriptan (Imigran)

Zolmitriptan (Zomig)

Can Pain Medication Help Trigeminal Neuralgia and Other Kinds of Facial Pain?

The normal answer to that question is that pain medication, including opioids, cannot help. This is true for most people. However, I know of several people in facial pain support groups who do find pain medication helpful.

Pain medication can’t prevent trigeminal neuralgia attacks in the way that anticonvulsants can but they might dull the pain for some people.

Doctors are often reluctant to prescribe pain medication because it can be addictive. This seems extremely unfair to anyone who might benefit from taking it.

What About Anti-inflammatories?

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help some types of pain and reduce inflammation. Just like pain medication, anti-inflammatories don’t normally help trigeminal neuralgia. However, some people do find them helpful, especially when used alongside an anticonvulsant medication.

However, if you are taking an anti-inflammatory regularly, you must let your doctor know. Anti-inflammatories can interact with other medications. They are not suitable for people with some health conditions like asthma or stomach ulcers. They can also cause stomach problems if taken regularly, so you need to take a stomach protector at the same time. Your doctor will be able to prescribe that.

Examples:
Ibuprofen (Advil, Motrin)

Naproxen (Aleve)

Diclofenac (Voltaren)

Indomethacin

Finding the Right Medication Can Take Time

Finding the best medication for facial pain can take some time. It could mean finding the right dose of one medication or it could mean finding a combination of two or more medications. Perhaps lower doses of two anticonvulsants would work better than an extremely high dose of one. Or perhaps a combination of an anticonvulsant, antidepressant and an anti-inflammatory would help.

But it’s not just a case of finding something to help the pain. It means finding something that helps without giving patients terrible side effects.

Unfortunately, so many facial pain medications can come with side effects. Some aren’t too bad and might wear off after a short time. Sometimes it’s worth putting up with mild side effects if the medication is helping the pain.

Advice on Dealing With Medication Side Effects

But sometimes the side effects are more difficult to cope with. If so, speak to your doctor. And some side effects such as rashes, unexplained bruising, breathing difficulties, low mood or thoughts of harming yourself are serious. They should never be ignored so contact your doctor straight away. They will probably advise you to stop that medication.

Always seek medical advice before stopping or changing dosage of medication.

Never Give Up Hope

When you need to stop a medication, there are other options so don’t give up hope. It does mean you need to go back to the drawing board but hopefully you’ll find another medication to help. There are also alternative treatments as well as medical procedures and surgeries. I’ll write about them in another post.

If your pain is out of control and you are unable to cope, there are medications that can be given via IV which might help. Please check out my post about emergency treatments.

Medical advice – I am not medically qualified. The posts on Despite Pain are written using my experience and knowledge as a patient. They are not intended as a substitute for medical advice from a health care professional.