From An Upper Cervical Chiropractic Perspective


TN sensory dermatomes

What is Trigeminal Neuralgia and what causes it?

What is Trigeminal Neuralgia? What does Trigeminal Neuralgia feel like? What causes this facial pain according to medicine and why can upper cervical chiropractic procedures help?

Trigeminal Neuralgia – the most severe facial pain?

Trigeminal neuralgia (TN) is a type of facial pain that is rare but often very severe, perhaps the most severe painful affliction of the face.

(Female patients with the severe form of this problem might say that TN pain eclipses the pain of childbirth.)

Neuralgia means “inflammation of the nerve” and Trigeminal refers to the Trigeminal nerve, or the fifth cranial nerve. It’s called the Trigeminal because it travels in three different branches that take feeling sensations from the top, middle, and bottom of the face back to the brain stem, where it’s then felt in higher centers in the brain.

TN pain can be so severe that some have considered death a better alternative than living with trigeminal neuralgia attacks, giving rise to its historical nickname as “the suicide disease.” (1)

Other TN cases remain mild in comparison.

Appearing in yellow are the multiple branches of the Trigeminal Nerve

Though it can occur at any age, it usually occurs in the middle-aged and elderly. It is also more prevalent in women than in men.

The medical perspective (and some chiropractors agree) is that there is no cure for a true case of Trigeminal Neuralgia (perhaps outside of surgical treatment if its successful).

Many experts say that that temporary remission or pain relief is often achievable even if complete and permanent remission is very unlikely. (2)

However, sometimes the belief in the incurable nature of TN can be a self-fulfilling prophesy. Any time a TN patient goes into a long-term remission from their facial pain, their physician may say that their case was not truly a disease of the Trigeminal Nerve.

What are the symptoms of Trigeminal Neuralgia?

According to the International Headache Society (IHS), trigeminal neuralgia (also known as tic douloureaux) is defined as “a sudden, usually unilateral, severe, brief, stabbing recurrent pain in the distribution of one or more branches of the fifth cranial nerve.“ (3)

Sudden, excruciating pain, lasting from a few seconds to several minutes or hours, is the most frustrating and common identifying feature of trigeminal neuralgia. Attacks may come and go, sometimes triggering bursts of pain in quick succession. Patients with TN often complain of the following: (4)

  • Sudden occurrence or abrupt worsening of pain
  • Severe pain attacks characterized as stabbing or electric-like shock
  • Attacks are usually limited to a few seconds, sometimes lasting up to 2 minutes
  • Pain attacks ranging from once to over 50 times a day
  • Stimulus-evoked pain, for example from speaking, brushing of the teeth, or chewing certain kinds of foods

The central area of the face, as well as around the nose and mouth (nasolabial fold) are common TN trigger zones. Any tactile stimuli, facial movement, and the subtlest stimulus can provoke an attack, such as:

  • Light touch
  • Whiff of air
  • Shaving
  • Applying make-up
  • Brushing teeth
  • Smiling or talking
  • Eating or drinking

What are the causes of Trigeminal Neuralgia?

We’ll start with the textbook medical perspective, and then explore the experience of chiropractors using the upper cervical chiropractic procedures.

Typical vs Atypical TN Pain

TN is said to be either typical or atypical in nature.

The differences between the TN types is largely one of severity of pain. The first type produces extreme shocking pain, while the other type is less common and less extreme.

TN sensory dermatomesThe classic explanation: compression of the Trigeminal Nerve Root

The textbook response for the cause of TN is compression of the trigeminal nerve root. As this nerve transmits touch and pain sensations from the teeth, mouth, and face back to your brain, we’re talking about a relatively large nerve in a compact area.

The wide distribution of the Trigeminal Nerve means that compression or irritation of the nerve could theoretically happen many places in the head, face or, jaw, or deep behind the face. For example, inflammation around a blood vessel, or inflammation from an sinus infection could put pressure on the nerve root and cause pain.

The problem with the classical explanation?

While other nerve entrapment and compression can be easy to see on an MRI (think lumbar disc on a lumbar nerve root), TN entrapment or compression can be very hard to find on imaging.

Other nerve compression syndromes can also be diagnosed by mechanically stimulating the problem area (Carpal Tunnel Syndrome or Brachial Plexus injury for example) and then relieving it by changing the patient’s position. With its sudden appearance and disappearance and no consistent response to a stimulus, TN pain is hard to diagnose.

The other times facial pain appears

There are also other times that a TN-like facial pain appears that can cause us to question the classic compression on nerve theory. Facial pain can appear with:

  • Multiple sclerosis (and other dymelinating disorders)
  • High blood pressure
  • Injuries or problems that put pressure on the brain stem or spinal cord below the trigeminal nerve root
  • Functional irritations to associated nerves that feed the trigeminal nerve cells in the spinal cord

A functional explanation for TN facial pain based on the experience of upper cervical chiropractic care

The experience of many TN patients in upper cervical chiropractic offices suggests that many cases of TN diagnosed facial pain are not actually true anatomical compression of the Trigeminal Nerve root in the skull or face.

Read more: Four stories about Trigeminal Neuralgia and upper cervical care from the Facial Pain Foundation

Many TN patients treated for upper cervical subluxation (misalignment) with upper cervical procedures will go through long periods of remission (sometimes after years of suffering), suggesting that facial pain is not from a truly damaged trigeminal nerve, but could be an extreme form of nervous system over-excitement to the trigeminal nerve complex in the brain stem. (5)

Where could this over-excitement originate?

Largely forgotten by many neurologists and other practitioners, there are neuron extensions from the trigeminal nerve nucleus in the brain stem that travel all the way down to the joint complexes of the C2 vertebra in the neck.

Chronic mechanical irritation to the mechanical receptors (mechanoreceptors) in the C2 vertebra is one way that over-excitement could reach the trigeminal nerve root cells, and then cascade outward in the form of pain and other sensations in the trigeminal nerve root.

In this example, TN facial pain may not originate from an anatomical compression of the nerve, but due to a functional irritation to an area of the brainstem!

In these cases, even a debilitating and mysterious pain can sometimes suddenly go into remission for months to years with a release and correction of the upper cervical spine (like in this case for example: Excruciating facial pain not responding to medication).

Look for our next article on Trigeminal Neuralgia treatments, which will be published soon.

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.


1. Stiles A, Evans J. Trigeminal neuralgia and other facial pain. Neurology 2007; 835-843.

2. Hannah DW. Iatrogenic trigeminal neuropathy with resultant atypical facial fasciculation of the zygomaticomandibularis: Chiropractic and dental co- management [case report]. J Acad Chiropr Orthoped 2007; 4(1).

3.  Merskey H, Bogduk N. Classification of chronic pain. Descriptors of chronic pain syndromes and definitions of pain terms. 2nd ed. Seattle: IASP Press; 1994.

4. Cruccu G, Finnerup NB, Jensen TS, et al. Trigeminal neuralgia: New classification and diagnostic grading for practice and research. Neurology. 2016;87(2):220-8.

5. 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.

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