What are the treatment Options for Trigeminal Neuralgia facial pain? From drugs, to surgery, to upper cervical chiropractic procedures, we cover some of the primary options that facial pain patients have in health care.
What is Trigeminal Neurgalgia and what causes it?
Trigeminal Neuralgia (TN) causes severe facial pain. There is no gold-standard medical device or pathological test that’s conclusive for the condition. That means the diagnosis is clinical based on symptoms.
There is no known universal cause for TN pain that’s recognized by medial authorities.
(A more detailed description is provided here: What is Trigeminal Neuralgia and what causes it? Anyone new to this condition should consider starting there.)
What are the goals of treating TN pain?
The main goal of treating TN is to relieve the patient of pain.
Treatment for trigeminal neuralgia includes medications, surgery, trigeminal nerve block, and other complementary pain management approaches like nutritional therapy, biofeedback, yoga, low-impact exercise, and meditation.(1)
Upper cervical chiropractic care is another option for TN pain patients, and is best understood as a way to correct an underlying biomechanical irritation of the TN nerve, rather than as a medical pain management.
My hope is that medical professionals educate their patients on all aspects of management and on what to expect from different treatment options, including the upper cervical chiropractic procedures.
What are the medical treatments for Trigeminal Neuralgia Facial Pain?
Medical approaches involved pharmaceuticals and a short list of surgical options.(2)
(Keep in mind that this is a chiropractic website, and this article is not meant to present personal comments on the effectiveness or the experience of TN patients taking these drugs which is outside the scope of chiropractic practice. Instead, reports from some of the literature are presented below.)
What oral drug therapy is available for Trigeminal Neuralgia facial pain?
Carbamazepine and oxcarbazepine are the first-line of drug treatments for Trigeminal Neuralgia.
Multiple drugs may be helpful if patients can’t tolerate higher doses of carbamazepine. Although less effective at controlling pain than carbamazepine, oxcarbazepine has a better safety profile, with fewer potential side effects.(3)
If either of these two drug therapies don’t work, then doctors may prescribed from the anti-seizure family of drugs.
-
- Gabapentin (900-3,600 mg/day)
- Pregabalin (150-600 mg/day)
- Tocainide (20 mg/day)
- Topiramate (100-400 mg/day)
- Valproate (600-2400 mg/day)
Botox injections for TN?
Botulinum toxin (BoNT) injection has is said to have analgesic effect in small, uncontrolled clinical trials. However, in at least one study, most patients treated with BoNT at 3.22 units/cm2 experienced gradual return of symptoms after 60 days. (4)
What are the surgical options for TN?
Surgical procedures are reserved for patients with severe, debilitating pain that does not respond to least three medications, including carbamazepine.
(Obviously I am of the opinion that all TN patients should experience a course of upper cervical chiropractic care before opting for surgery.)
- Gamma Knife Radiosurgery – the only non-invasive surgical treatment for TN performed in the outpatient center. It involves targeting the trigeminal root in the posterior fossa with a focused beam of radiation.
- Microvascular decompression – while it is known to provide the most sustained pain relief, it is a major surgical procedure that requires craniotomy (removing a part of the skull to expose the brain).
- Glycerol injection – a thin needle is injected into the cheek through the opening in the base of skull.
Anyone considering these surgeries should be able to reach out to other patients who have opted for these procedures via online support groups, and the like.
One resource to contact is the support network of the Facial Pain Association.
Any surgery will have a potential for either side effects or injury during the surgery itself, so patients need to take these risks into account.
Upper cervical chiropractic care for Trigeminal Neuralgia pain?
Some patient decide to use chiropractic techniques combined with drug treatment to manage their TN attacks.
Often times patients are already on pain medications when they arrive at upper cervical chiropractic office, and the upper cervical correction allows them to taper off the meds under the help of their physician.
Some patients prefer simply managing their pain with upper cervical chiropractic care because it’s non-invasive and provides significant pain reduction in many cases.
It is highly important that TN patients know that general chiropractic procedures may provide some TN relief, however, the experience of many TN patients points to the effectiveness of working with a chiropractor who uses upper cervical chiropractic procedures.
Is there a connection between upper neck and head trauma and Trigeminal Neuralgia?
Yes, those with a history of neck trauma may reveal misalignment of the upper cervical spine if the evaluation includes a biomechanical or upper cervical chiropractic perspective. This imaging may be achieved through
- Upper cervical x-ray procedures (For example NUCCA, Orthospinology, Blair)
- Cone beam computed tomography (CBCT) which is evaluated for minor C1/C2 misalignments
- Upright MRI with Cranio-Cervical Junction Technique (CCJ)
Damage to the upper cervical ligaments and other soft tissue may be visible with specialized MRI which includes specialized CCJ views, whereas the CBCT and x-ray document misalignment.
Does upper neck imaging show compression of the Trigeminal Nerve and that’s why upper cervical chiropractic care helps?
No. Imaging that shows injury or misalignment in the upper neck will not show compression of the TN nerve, which is up in the mid brain steam.
Instead its understood to reveal an underlying cause of TN pain, resulting in congestion or irritation of the trigeminal nucleus which has extensions down into the spinal cord. Direct compression on the TN nerve is hard to document in TN.
Patients should know that if imaging does not include an upper cervical chiropractic perspective, then patients who undergo these studies will receive reports that don’t comment on upper cervical alignment, and they may never learn of the connection between the upper neck and TN pain.
Chiropractic care for Trigeminal Neuralgia case reports
- A 68-year old female patient with over 7-year history of worsening head and neck reported quick relief and reduced pain subsequent to a long duration of symptoms.(5)
- A 40-year old with right-sided trigeminal neuralgia (10 out of 10 pain rating) of 6-month duration experienced pain relief after diversified adjusting technique and supine rotary breaks to C1 and C2. The patient stopped taking her pain medications and no relapse has been reported after eight years of maintenance care.(6)
- Another young female patient suffering from severe, intermittent left facial pain below the eye and radiating into the jaw experienced complete remission of symptoms after only one spinal adjustment.(7)
Experiences of facial pain patients in our Auburn Hills office
Below are links to some cases which include resolution of facial pain:
- Excruciating facial pain not responding to medication
- Facial pain before and after neck alignment (video)
- Coming off trigeminal neuralgia meds after upper cervical chiropractic
Would you like a second opinion on your facial pain diagnosis, or would you like to be screened for a structural problem in your neck that may be contributing to your facial pain symptoms? Please use the contact form below.
References:
- 1. Trigeminal Neuralgia Fact Sheet | National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet.
- 2. Obermann M. Treatment options in trigeminal neuralgia. Ther Adv Neurol Disord. 2010;3(2):107-15.
- 3. Beydoun A. Safety and efficacy of oxcarbazepine: results of randomized, double-blind trials. Pharmacotherapy. 2000;20(8 Pt 2):152S-158S.
- 4. Piovesan EJ, Teive HG, Kowacs PA, Della Coletta MV, Werneck LC, Silberstein SD. An open study of botulinum-A toxin treatment of trigeminal neuralgia. Neurology. 2005;65(8):1306-1308. doi:10.1212/01.wnl.0000180940.98815.74
- 5. Rodine RJ, Aker P. Trigeminal neuralgia and chiropractic care: a case report. J Can Chiropr Assoc. 2010;54(3):177-86.
- 6. Zielinski E, Acanfora M. Resolution of Trigeminal Neuralgia Following Subluxation Based Chiropractic Care: A Case Study & Review of Literature. Annals of Vertebral Subluxation Research. 2013:33-34.
- 7. Kessinger R, Matthews A. Resolution of Trigeminal Neuralgia in a 14 Year Old Following Upper Cervical Chiropractic Care to Reduce Vertebral Subluxation: A Case Study. J Upper Cervical Chiropr Res. 2012:77-84.
Image Credits:
Atlas/Axis longitudinal slice by Henry Vandyke Carter – Henry Gray (1918) Anatomy of the Human Body (See “Book” section below)Bartleby.com: Gray’s Anatomy, Plate 308, Public Domain, Link
Neurovascular Compression of Trigeminal Nerve by Luigi Berra [CC BY-SA 4.0], via Wikimedia Commons
Trigeminal Neuralgia by BruceBlaus [CC BY-SA 4.0], via Wikimedia Commons
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