If I left it up to my Neurologist, I would just keeping upping my meds and trying new meds forever.
Last year I had a TN attack so bad I went to the emergency room. The attack started with a huge pop in my right ear followed by what I can only describe as contractions of pain lasting 2-3 minutes long and 3-4 minutes apart. This went on for hours and I maxed out every drug I had. I called my doctor in tears asking what to do. His response was, "Go to the E.R you idiot." (Not very professional) I went to the E.R and they told me I had a sinus infection and an ear infection.
The next day I made an appointment with an ear specialist a friend recommended. After telling him what the last 6 years had been like he asked why I had not seen a neurosurgeon. Why didn't I think of that!
I met with the NS a week later. He told me about Gamma and MVD. We decided to try Gamma. I got relief from about 90% of my pain for 9 months. It was wonderful. I called my neurologist and let him know what we were doing. He seemed very disinterested. All he cared about was my meds. I never went off my meds but dropped from 2000mg of Carbitrol to 600mg a day.
I realized my Neuro would never have sent me to a surgeon. He isn't interested in healing me. That would be less cash for him and it would bruise his ego. I now have 2 neuros. But when it comes to making choices about surgery, I educate myself and talk to Neurosurgeons. I have found a great group of specialists. Luckily, in my area.
Moral of this story; You have to be pro-active and educate yourself. There my be options out there your doctor won't suggest for whatever reason.
It's your health.