Can duloxetine improve trigeminal neuralgia? (+alternatives)

This article will discuss duloxetine’s effectiveness in managing trigeminal neuralgia. It will explore the mechanisms through which duloxetine may improve the pain associated with this condition.

The article will also summarise the findings from research studies investigating duloxetine’s efficacy for trigeminal neuralgia. Additionally, it will highlight the potential side effects of using duloxetine for this disease and provide alternative treatment options for those who do not respond to duloxetine.

Can duloxetine improve trigeminal neuralgia?

Yes, duloxetine can help with trigeminal neuralgia in some people. However, the use of duloxetine for trigeminal neuralgia is considered off-label, as it is not FDA-approved for this condition.

Trigeminal neuralgia is a chronic pain disorder that affects the trigeminal nerve, which is located in the face. This disease is associated with severe facial pain that intensifies upon eating, speaking, laughing, or even touching the face.

Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) that is commonly used in treating neuropathic pain. Multiple case reports and studies suggest that it can improve trigeminal neuralgia-related pain in some individuals [1]. 

However, as people respond differently to medications, duloxetine may not be effective in improving trigeminal neuralgia symptoms for everyone. Therefore, it is essential to consult with a healthcare professional before using it for this condition.

How can duloxetine help with trigeminal neuralgia?

First of all, duloxetine increases the levels of norepinephrine and serotonin, both of which are involved in regulating pain. Additionally, it blocks N-methyl-D-aspartate (NMDA) receptors, which play a role in transmitting pain signals [2].

It is also important to understand that trigeminal neuralgia causes pain through the “ignition hypothesis”. In this condition, a single hyperexcitable neuron can rapidly activate a large number of neurons, leading to the onset of pain [2].

It is suggested that duloxetine may modulate the excitability of these neurons through its NMDA antagonism, potentially relieving trigeminal neuralgia symptoms and pain [2].

What does research suggest?

One study investigated the efficacy of duloxetine in improving trigeminal neuralgia symptoms. It was found that 60% of the patients who received duloxetine experienced significant pain relief.

Additionally, it was stated that these patients observed an improvement in their symptoms within the first week of starting duloxetine treatment, and this improvement was sustained for a duration of 4 months [3].

Furthermore, a case study demonstrated that duloxetine was effective in treating persistent trigeminal neuralgia that had previously been unresponsive to various treatments [2].

To illustrate, over the course of three years, a woman with trigeminal neuralgia tried multiple approaches, including carbamazepine monotherapy, a combination of diclofenac, carbamazepine, baclofen, valproate, and acetaminophen, as well as multiple gamma knife radiosurgeries. However, her pain did not improve [2].

Consequently, she developed depression and started taking duloxetine. One week after increasing her fuloxetine dose to 60 mg per day, she finally experienced significant relief from her trigeminal neuralgia pain. Four years later, she remained free from trigeminal neuralgia [2].

What are the side effects of using duloxetine for trigeminal neuralgia?

The use of duloxetine for trigeminal neuralgia may be associated with certain side effects. These potential side effects include [1]:

What to do if duloxetine doesn’t help with trigeminal neuralgia?

If duloxetine does not provide relief for trigeminal neuralgia, it is important to consult with your doctor. They may consider adjusting the dosage of duloxetine or switching to a different medication that may be more effective at managing this disease.

Furthermore, your doctor may consider adding another medication, such as an anticonvulsant like pregabalin, an analgesic like acetaminophen or Ibuprofen, or an opioid, to enhance pain control.

If these pharmacological approaches don’t work, the physician may suggest trying targeted injections of anesthesia or steroids to relieve pain in the affected area.

Finally, surgical interventions such as nerve decompression, microvascular decompression, or radiofrequency ablation may be helpful for improving treatment-resistant trigeminal neuralgia [4,5]

What other medications can help with trigeminal neuralgia?

Several medications can be used to treat this condition instead of duloxetin. For instance, trigeminal neuralgia treatment typically begins with either one of two anticonvulsants: carbamazepine or oxcarbazepine.

If these medications do not effectively manage this condition, doctors may recommend combination therapy. For example, they may suggest adding medications such as gabapentin, pregabalin, lamotrigine, phenytoin, baclofen, and botulinum toxin type A to carbamazepine or oxcarbazepine [6].


In conclusion, based on my research, duloxetine can be helpful in managing trigeminal neuralgia for some individuals. Although it is not FDA-approved for this condition and is considered off-label, multiple case reports and studies demonstrate its efficacy in relieving trigeminal neuralgia-related pain.

Furthermore, I found that side effects of duloxetine for trigeminal neuralgia may include nausea, constipation, dry mouth, dizziness, and sexual dysfunction, among others.

If duloxetine does not provide relief, I recommend consulting with a doctor, as I believe they may consider adjusting the dosage, try other medications, recommend non-pharmacological interventions like nerve decompression or surgical procedures.

Based on my knowledge, alternative medications for trigeminal neuralgia include carbamazepine, oxcarbazepine, gabapentin, pregabalin, phenytoin, and baclofen.

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Dhaliwal JS, Spurling BC, Molla M. Duloxetine. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:


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