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Ramsay Hunt Syndrome Treatments and Medications

Creator: SingleCare
Published: 12-23-2020

Medically reviewed by Gerardo Sison, Pharm.D.

Licensed Pharmacist

Updated Dec. 23, 2020 • Published Dec. 23, 2020

Fact Checked

Experiencing a painful shingles rash and facial paralysis can be extremely difficult to deal with both physically and emotionally. These are just some of the symptoms of the neurological disorder called Ramsay Hunt syndrome. Understanding what Ramsay Hunt syndrome is and how to treat it both at home and with medications are great steps toward managing the condition. Let’s take a look at some of the best treatments and medications for Ramsay Hunt syndrome.

What is Ramsay Hunt syndrome?

Ramsay Hunt syndrome (RHS) is a rare neurological condition that causes a severe rash and facial paralysis. It’s considered to be a complication of the varicella zoster virus (VZV), which is the same virus that causes chickenpox and shingles. The disorder is sometimes called herpes zoster oticus or geniculate neuralgia because it occurs when the varicella zoster virus infects the facial nerve near one of the ears.

The most common symptoms of Ramsay Hunt syndrome are a painful rash, facial paralysis, and hearing loss in the affected ear. It can also cause changes in taste, ear pain (otalgia), tinnitus, dry eye, nausea, and vertigo.

Ramsay Hunt syndrome is very rare－less than 1% of zoster cases result in the condition. Although it’s rare, the Journal of Neurology, Neurosurgery, and Psychiatry says that Ramsay Hunt syndrome is the second most common cause of atraumatic peripheral facial paralysis.

The good news is that there are treatment options available for people experiencing RHS. Medications are the most common treatment option, but some people also find relief from their symptoms by using natural remedies.

How is Ramsay Hunt syndrome diagnosed?

When a shingles outbreak affects the facial nerve near one of the ears, the first symptoms to appear will likely be a blistering rash near the ear canal and partial facial weakness or paralysis on the affected side of the face. These symptoms are often how doctors will diagnose someone with Ramsay Hunt syndrome, though a complete medical history and physical examination will also be needed to make an accurate diagnosis. In some cases, a doctor may take a fluid sample from a rash blister or run blood tests to confirm a diagnosis.

The first healthcare provider that someone with Ramsay Hunt syndrome is likely to see for their condition is a family doctor or general care practitioner. In some cases, a family doctor may refer patients to a neurologist who specializes in nervous system disorders or to an otolaryngologist who specializes in the ear, nose, and throat. Here are some questions that you may need answers to if you’re about to see a doctor:

Have you ever had chickenpox or shingles before? If so, when?
Have you ever had the chickenpox vaccine?
When did your symptoms start? What are your symptoms?
Do you have any chronic illnesses or health conditions?

Anyone who has previously had chickenpox or shingles can get RHS, but older adults and those with compromised immune systems are more likely to get it. Anyone with Ramsay Hunt syndrome who has a blister-like rash should avoid physical contact with pregnant women, newborns, immunocompromised people, and those who’ve never had chickenpox to avoid passing the virus on to them.

Ramsay Hunt syndrome treatment options

Once someone has the varicella zoster virus, it remains inactive in their body for the rest of their lives. For this reason, there’s no cure for the underlying cause of Ramsay Hunt syndrome, but the symptoms it causes can be successfully treated. According to the International Archives of Otorhinolaryngology, patients who receive an early diagnosis and are treated appropriately have high rates of complete recovery.

Treatment of Ramsay Hunt syndrome is largely focused on medication. Medications help control viral infection, decrease inflammation, and reduce pain. Some lifestyle changes may help strengthen the immune system and prevent further flare-ups, like eating a healthy diet full of fresh fruits and vegetables and getting regular exercise. Home remedies like cold compresses can also be used to minimize pain.

It’s important to seek treatment for Ramsay Hunt syndrome as soon as possible to prevent potential complications. If it goes untreated for too long, complications can develop like permanent facial paralysis, corneal ulcers, muscle weakness, inappropriate nerve responses (synkinesis), and nerve pain. If you’ve had chickenpox and start to have any of the symptoms of Ramsay Hunt syndrome, it’s best to get treatment as soon as possible.

Ramsay Hunt syndrome medications

There are many different types of medications that can be used to treat Ramsay Hunt syndrome. The type of medication you’ll need will depend on your individual symptoms and medical history. Here are the groups of medications used to treat RHS.

Antiviral medications

Antivirals are the first line of treatment against Ramsay Hunt syndrome because they help prevent viral infections from spreading. Studies show that antiviral medications can reduce or minimize nerve damage and improve the chance of facial weakness improving or resolving for people with RHS. The most commonly prescribed antivirals for the condition are Zovirax, Famvir, and Valtrex. Antiviral medications have been known to cause side effects like headaches and dizziness.

Anti-anxiety medications

Sometimes doctors will prescribe patients with Ramsay Hunt syndrome the anti-anxiety medication Valium because it can help relieve symptoms of vertigo. Valium is a benzodiazepine that works by enhancing the effects of GABA, an inhibitory neurotransmitter. These groups of medications have been known to cause side effects like drowsiness and unsteadiness.

Corticosteroids

Corticosteroids are often prescribed in combination with antivirals because they have a strong anti-inflammatory effect. Steroids reduce inflammation and edema in the nerves, which can help accelerate recovery in affected nerves. Prednisone is probably the most common steroid prescribed for Ramsay Hunt syndrome, and, when it’s combined with the antiviral acyclovir within seven days of onset, it can prevent nerve degeneration and enhance the recovery rate of facial nerve palsy. Side effects of short-term corticosteroid use may include headache, nausea, and increased blood pressure or blood sugar levels.

Pain relievers

When corticosteroids aren’t enough to relieve pain associated with Ramsay Hunt syndrome, prescription pain relievers may be needed. There are many different types of prescription pain medications that a doctor can prescribe, including but not limited to Vicodin, OxyContin, and codeine. Over-the-counter pain medications like ibuprofen may be started first for more mild pain. Other medications like gabapentin or carbamazepine may also be used to treat pain. Prescription opioid pain relievers can be very addicting and should be taken with caution.

What is the best medication for Ramsay Hunt syndrome?

Everyone will experience Ramsay Hunt syndrome a little differently, and there isn’t one medication that will work best for everyone. Your doctor can recommend or prescribe the right medication for you based on your individual symptoms, medical history, and response to treatment. The following table lists some of the most popular Ramsay Hunt syndrome medications your doctor might prescribe or recommend.

Best medications for Ramsay Hunt syndrome
Drug Name	Drug Class	Administration Route	Standard Dosage	Common Side Effects
Zovirax (acyclovir)	Antiviral	Oral	800 mg five times per day for 7-10 days	Nausea, diarrhea, headache
Famvir (famciclovir)	Antiviral	Oral	500 mg three times per day for seven days	Headache, nausea, fatigue
Valtrex (valacyclovir)	Antiviral	Oral	1 g taken three times daily for seven days	Stomach pain, nausea, headache
Valium (diazepam)	Benzodiazepine	Oral	Taken as directed by a medical professional	Drowsiness, unsteadiness, and headache
Prednisone	Corticosteroid	Oral	60 mg per day for five days	Fluid retention, headache, increased blood pressure
Vicodin (hydrocodone)	Opioid	Oral	Taken as directed by a medical professional	Dizziness, lightheadedness, and drowsiness

Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.

What are the common side effects of Ramsay Hunt syndrome medication?

All medications have the potential to cause side effects, and Ramsay Hunt syndrome medications are no exception. Here are some of the most common side effects people may experience from RHS medications:

Tiredness
Dizziness
Trouble sleeping
Headache
Nausea
Irritability
Trouble concentrating
Lack of appetite
Flu-like symptoms
Lightheadedness
Vomiting
Chills
Lower back pain

Some side effects of Ramsay Hunt syndrome are more serious and may require medical attention. If you’ve taken medication and start to have difficulty breathing or swelling of the face or throat, you should seek medical attention as soon as possible. These are signs of an allergic reaction, which could be life-threatening.

The corticosteroids and pain relievers that are sometimes prescribed for Ramsay Hunt syndrome have been known to cause more serious side effects. If you’re taking a corticosteroid or prescription pain reliever and start to experience mood changes, or feel depressed, severely tired, or confused, you should seek medical help as soon as you can.

This list of side effects is not comprehensive. It’s best to talk to a healthcare professional for a complete list of possible adverse events and drug interactions.

What is the best home remedy for Ramsay Hunt syndrome?

Many people find relief from the discomfort of Ramsay Hunt syndrome by using home remedies. Certain lifestyle changes and natural and home remedies can help prevent flare-ups or prevent episodes of the condition from recurring. Here are some of the best home remedies for RHS.

Using a cool, wet compress

To help ease pain from Ramsay Hunt syndrome, a cool, wet compress can be applied to painful areas as often as needed.

Using over-the-counter pain medications

At the first signs of pain, it may be worth trying over-the-counter pain medications like ibuprofen. If your pain worsens, however, you may need a stronger prescription pain reliever.

Wearing an eye patch

Some people with Ramsay Hunt syndrome will have weak facial muscles that make it difficult to close one of their eyes. This can leave the cornea, which protects the eye, exposed to outside dirt and abrasions. Wearing an eye patch can keep the eye from getting damaged at night, and eye drops can help keep the eye properly moisturized throughout the day.

Frequently asked questions about Ramsay Hunt syndrome

How long does it take for Ramsay Hunt syndrome to go away?

Everyone will recover from Ramsay Hunt syndrome a little differently, but in general, it takes about three weeks to recover completely. In rare cases, some people will develop postherpetic neuralgia, which is pain caused by damaged nerve fibers that can last months or years.

What is the treatment for Ramsay Hunt syndrome?

Treatment for Ramsay Hunt syndrome will likely involve taking prescription medications, like antivirals and corticosteroids. Home remedies can also help relieve mild pain and discomfort.

Is Ramsay Hunt syndrome curable?

The underlying cause of Ramsay Hunt syndrome, varicella zoster virus, isn’t curable because it will always lie inactive in the body. Effective treatment can make symptoms go away but there is always the potential for the virus to flare-up again.

What triggers Ramsay Hunt syndrome?

Ramsay Hunt syndrome happens when the varicella zoster virus reactivates and spreads to the geniculate ganglion of the 7th cranial nerve on one side of the face. Reactivation of the virus could be caused by a drop in immune system health or emotional or physical trauma.

Related resources for Ramsay Hunt syndrome