Do you find onabotulinumtoxinA injections effective for the treatment of trigeminal neuralgia?

I use botulinum toxin (off-label) for two face pain conditions, one rare, i.e., trigeminal neuralgia, and one common, i.e., temporomandibular disorder (TMD). For trigeminal neuralgia, I use a tiny needle to inject very small amounts of the toxin into the affected area of the skin and, if involved in...

I've had a very similar experience with Dr. @Dr. First Last, treated several at least dozens, perhaps (>)> 100 patients with trigeminal nerve pain in my former clinics at Duke. There were approximately ½ of those who suffered neuralgic attacks, most with underlying continuous pain, and very few with...

For TMJ disorders (TMJD), I administer low-dose Botox injections into both the temporalis and masseter muscles, targeting 2-3 sites per muscle dose depending on the severity of symptoms and muscle size. For trigeminal neuralgia, I use a superficial injection technique, applying Botox in a grid-like ...

I have never used it. From a quick literature review, there is limited evidence for efficacy. There have been case reports/series, and small prospective observational studies. There is a recent meta-analysis by Hu et al., PMID 38385501, where they reported four RCTs and several observational studies...

I use onabotulinumtoxinA in patients with trigeminal neuralgia who have not responded to first line treatments. Usually I will have tried carbamazepine or oxcarbazepine, lamotrigine, and gabapentin/pregabalin at least before trying. I particularly try if surgical treatment is not an option. I have s...

Botox is not covered by insurance for trigeminal neuralgia in the US, nor is TMJ, so their use is limited in general.

I use spinal cord stimulation (SCS) for trigeminal neuralgia, and it has been a life changing procedure for most of my trigeminal neuralgia patients, after years of failed attempts a...