Benzodiazepines and trigeminal neuralgia

[paranoid android]

Why does clonazepam seem to be the preferred benzo for treating TN? Does it have properties other benzos don't? I find bromazepam better for anxiety but i dont want to switch all the way if it's gonna risk making my TN worse

 

[AlphaMethylPhenyl]

TN is usually well-treated with Tegretol and Trileptal. Clonazepam doesn't have much research to back it up. I mean I couldn't find any studies suggesting its use, just a note on the wikipedia page. Sounds super painful though. My sympathies, such as they are.

 

[paranoid android]

TN is usually well-treated with Tegretol and Trileptal. Clonazepam doesn't have much research to back it up. I mean I couldn't find any studies suggesting its use, just a note on the wikipedia page. Sounds super painful though. My sympathies, such as they are.

Im intolerant to both the only thing that i can get in Canada to help my TN is morphine.

 

[AlphaMethylPhenyl]

Im intolerant to both the only thing that i can get in Canada to help my TN is morphine.

You tried lamotrigine, baclofen, topiramate, levetiracetam, gabapentin, pregabalin, cannabinoids, eslicarbazepine, brivaracetam, lidocaine, misoprostol, phenytoin, fosphenytoin, pimozide, sodium valproate, sumatriptan, tizanidine, tocainide, tricyclic antidepressants, vixotrigine and botulinum toxin-A?

 

[paranoid android]

You tried lamotrigine, baclofen, topiramate, levetiracetam, gabapentin, pregabalin, cannabinoids, eslicarbazepine, brivaracetam, lidocaine, misoprostol, phenytoin, fosphenytoin, pimozide, sodium valproate, sumatriptan, tizanidine, tocainide, tricyclic antidepressants, vixotrigine and botulinum toxin

I tried carbamazepine, lamictal, depakote, gabapentin, lyrica and a few others im forgetting.

 

[Señor Moreno]

Yes, clonazepam is superior to other benzos as an anticonvulsant, I think that's why they choose it.
What I found to be effective (to a degree, as everything else when it comes to TN) is lidocaine: I wear a pumpimg device for a week every 3 months. I have to be on other meds that @AlphaMethylPhenyl and you listed above, but this lidocaine treatment is helping for sure. I suggest you to read about the subject and ask your doctor if she/he knows about this procedure being performed in your area or not. And, of course, feel free to PM me if you have any question about how it feels wearing it or whatever

 

[AngelsandFairiesarereal]

Clonazepam has muscle relaxant properties. I’m prescribed both clonazepam & a small amount as needed xanax. Both are prescribed for severe PTSD. But the clonazepam helps my neck & jaw issues where the Xanax does not.
I don’t know if that helps any but … for sure some benzos will help more with body/muscle relaxing properties than others
Big hug

 

[paranoid android]

Yes, clonazepam is superior to other benzos as an anticonvulsant, I think that's why they choose it.
What I found to be effective (to a degree, as everything else when it comes to TN) is lidocaine: I wear a pumpimg device for a week every 3 months. I have to be on other meds that @AlphaMethylPhenyl and you listed above, but this lidocaine treatment is helping for sure. I suggest you to read about the subject and ask your doctor if she/he knows about this procedure being performed in your area or not. And, of course, feel free to PM me if you have any question about how it feels wearing it or whatever

Ya my doc scripted me lidocaine nasal spray but i cant afford it right now. Lidocaine is not covered here

Clonazepam has muscle relaxant properties. I’m prescribed both clonazepam & a small amount as needed xanax. Both are prescribed for severe PTSD. But the clonazepam helps my neck & jaw issues where the Xanax does not.
I don’t know if that helps any but … for sure some benzos will help more with body/muscle relaxing properties than others
Big hug

Ya i get clonazepam and bromazepam and when i had a attack on tn last night bromazepam didnt really seem to help but clonaz did.

 

[Dead Machination]

My father-in-law has TN. It's caused him to need multiple intercranial surgeries, none of which has been particularly effective. He's been on just about every drug you can think of for it. It's still more or less debilitating. The only thing that he said helps him is gabapentin.

 

[Skorpio]

I always hear people saying that clonazepam blocks calcium channels, which is why it is the first choice anticonvulsant benzo, but it seems to block calcium channels at a thousand fold higher dose than the interaction with GABA receptors. I would be surprised if this affinity contributed to its therapeutic effects, unless there is some missing factor that either renders the receptors more facile to opening or increases the local concentration of clonazepam at those calcium channels.

 

[Señor Moreno]

My father-in-law has TN. It's caused him to need multiple intercranial surgeries, none of which has been particularly effective. He's been on just about every drug you can think of for it. It's still more or less debilitating. The only thing that he said helps him is gabapentin.

Fuck, poor man! This hardcore TN cases are truly horrible beyond words, one of the most painful shit in the world, an actual hell to endure.
I hope to God that he could find some kind of relief, even if temporary, even if partial

 

[AlphaMethylPhenyl]

I always hear people saying that clonazepam blocks calcium channels, which is why it is the first choice anticonvulsant benzo, but it seems to block calcium channels at a thousand fold higher dose than the interaction with GABA receptors. I would be surprised if this affinity contributed to its therapeutic effects, unless there is some missing factor that either renders the receptors more facile to opening or increases the local concentration of clonazepam at those calcium channels.

Probably blocks Na+ VGICs too, I'd guess.

 

[Skorpio]

Probably blocks Na+ VGICs too, I'd guess.

I've never seen any references to this, but it could explain some things.

 

[snmfmy]

TN is usually well-treated with Tegretol and Trileptal. Clonazepam doesn't have much research to back it up. I mean I couldn't find any studies suggesting its use, just a note on the wikipedia page. Sounds super painful though. My sympathies, such as they are.

I have 'fake pain' due to autoimmune sclerotic plaque in the brain immitating peripheral neuropathy and sometimes neuralgia type pain at TMJ/Trigeminal area.

Also tinnitus due to what my neurologist calls "auditory cortex/nerve static" from same lesions.

Clonazepam, Librium, and Diazepam, abolish the pain and tinnitus by increasing Signal-to-noise -- by reducing the static through some mechanism I'm not explicitly aware/informed of.

Gabapentin doesn't work, opiates don't work, strangely some Amphetamines and Methcathinones do to some degree (ones that are not NE heavy, otherwise the tinnitus gets worse).

Interestingly, Alprazolam, Lorazepam, and Temazepam do not decrease the pain, neuralgia, or tinnitus.

However, CLON, DZP, LIB work a trick, with Librium (chlordiazepoxide) being the best relief for the least sedation/benzo drag.

My current hypothesis is the NE inhibiting effect of benzos is the effective MOA. And that in me at least, it works. I have to also propose the MOA that leads CLONAZEPAM, DIAZEPAM, and CHLORDIAZEPOXIDE to be effective anti-seizure medication contributes, as seizure waveforms are inherently STATIC-LIKE.

Thoughts, comments?

 

[AlphaMethylPhenyl]

Just that I was under the impression that benzos probably inhibit glutamate much more than NE. For that there are beta blockers.

Also, maybe there's not a connection, but I was under the impression that all benzos save possibly midazolam at the delta sybtype don't activate opioid receptors appreciably, and that opioidergic activity is associated with less NE activity in the locus coeruleus, the main NE hub, pointing to GABA-A PAMs not really affecting NE much. Could be far off on this one.

Come to think of it, the ones you listed that don't work are of small-medium duration, at least taking pharmacokinetics into account, compared to the ones that worked for you. That's the main difference that I see.

 

[Flynnal]

autoimmune sclerotic plaque

WTF? I knew there was something to this. Maybe that's why I have screwed up hearing. Yep. Vascular causes, impeding blood flow to the ear. Yep. I knew this as soon as I read it.

BTW the day before I came down with COVID in December 2022 my hearing suddenly "perked up" but that did no last long, it was back to its shit self after a few days. I was honestly so glad I thought it finally had gone and I wouldn't have to deal with it...but I remember August 2022 that same shit distortion went away in left ear,,,but returned 3 days later. In the end I had to decide whether to put a knife through my right carotid or not. I was just so sick of it. And then in January 2023, another major episode hit my right ear. I then smashed myself up in the head about 30 times whilst throwing a psychotic meltdown giving myself a concussion and likely cognitive memory problems.

9 episodes so far. Mild to moderate SSNHL. Mostly recovered, but always always perma damage, distortion, pitches on one side on the lows and highs. Dizzy spells. Now have permanent balance problems when I turn my head. 10th episode I think is the going to be the one where I decide whether or not life is worth it.

Did Vaproate help you out in any way? I'm on that and it doesn't seem to do much, but it is helping a little bit.

 

[snmfmy]

WTF? I knew there was something to this. Maybe that's why I have screwed up hearing. Yep. Vascular causes, impeding blood flow to the ear. Yep. I knew this as soon as I read it.

Not related to blood vessels. Not a vascular cause at all. I sent you a PM.

(Sclerotic plaque, not Atherosclerotic plaque).

 

[snmfmy]

TN is usually well-treated with Tegretol and Trileptal. Clonazepam doesn't have much research to back it up. I mean I couldn't find any studies suggesting its use, just a note on the wikipedia page. Sounds super painful though. My sympathies, such as they are.

Trigeminal Neuralgia | New York Headache Center

nyheadache.com

Clonazepam has been reported to be effective in two thirds of patients with TN (17,18,19).

I copied and pasted the relevant citations.

17. Chandra B: The use of clonazepam in the treatment of trigeminal neuralgia. Mod Med Asia 1975;11:8-9.

18. Court JE, Kase CS: Treatment of tic douloureux with a new anticonvulsant (clonazepam). J Neurol Neurosug Psychiat 1976;39:297-299.

19. Smirne S, Scarlato G: Clonazepam in cranial neuralgias. Med J Aust 1977;1:93-94.

 

[snmfmy]

Just that I was under the impression that benzos probably inhibit glutamate much more than NE. For that there are beta blockers.

The Effects of Benzodiazepines on Orexinergic Systems in Rat Cerebrocortical Slices​

• March 2007
• Anesthesia & Analgesia 104(2):338-40

DOI:10.1213/01.ane.0000252413.62821.2e

• Source
• PubMed

We examined the interactions between OXergic neurons and benzodiazepine receptors in orexin-A (100 nM) and K+ (25 mM)-evoked norepinephrine release from rat cerebrocortical slices. Midazolam, diazepam, and flunitrazepam concentration-dependently inhibited both OX-A- and K+-evoked norepinephrine release.

I have read other places that agonism of GABA receptors can result in downstream inhibition of both dopamine and norepinephrine release.

 

[AlphaMethylPhenyl]

Trigeminal Neuralgia | New York Headache Center

nyheadache.com

Clonazepam has been reported to be effective in two thirds of patients with TN (17,18,19).

I copied and pasted the relevant citations.

17. Chandra B: The use of clonazepam in the treatment of trigeminal neuralgia. Mod Med Asia 1975;11:8-9.

18. Court JE, Kase CS: Treatment of tic douloureux with a new anticonvulsant (clonazepam). J Neurol Neurosug Psychiat 1976;39:297-299.

19. Smirne S, Scarlato G: Clonazepam in cranial neuralgias. Med J Aust 1977;1:93-94.

Your sources are just about antiques