Trigeminal Neuralgia is a painful condition affecting the face and head of individuals typically over the age of 50. This condition is more common in women than men. People suffering from trigeminal neuralgia will experience shock like pains, most commonly along the jaw or side of the face. This pain typically last anywhere from 6-10 seconds, but has been reported to last up to a minute in rare cases. Most people with this condition can attribute this sudden jolt of pain with triggering events. The most common triggers include: talking, swallowing, yawning, or eating certain foods.

Let's Look at the Anatomy

The trigeminal nerve spans most of the face and is thought to be the culprit in this condition as it supplies the sensory information from the face, head, mouth, nose and sinuses, as well as motor control to the muscles responsible for chewing. This bundle of nerves sits above the joint of the jaw (TMJ) in the temporal bone of the skull and branches out into three distinct sections: the ophthalmic nerve (the green zone), the maxillary nerve (the pink zone), and the mandibular nerve (the purple zone). Most commonly, the pain can be felt along the maxillary and mandibular regions spanning the jaw and side of the face.

Other Conditions to Consider

Trigeminal Neuralgia is very rare and there are many other conditions that should be considered when your doctor is making a diagnosis. Proper management of this condition is based on the source of pain. Meaning that just because a person is experiencing pain along the trigeminal nerve, an appropriate diagnoses must be made as to the exact mechanism of nerve irritation in order deliver the right treatment method. Here is a list of the most common causes that can also cause facial pain.

- Inflammation in the mouth -- This can come as a result of dental cavities, a cracked tooth, trauma, or dental surgery. Infection or inflammation may spread through the tiny holes in the tooth that connect to the bone, compressing or irritating the mandibular branch of the trigeminal nerve. This will cause the teeth to become sensitive to compressive pressure, and also hot or cold foods. Sometime sweets will cause pain as well.

- Muscle strain -- As we discussed earlier. The trigeminal nerve supplies the motor control to the muscles used during chewing. If someone has a history of grinding their teeth at night or during the day, these muscles eventually get tired and irritated. This will cause pain around the jaw and/or temples when opening the mouth. The pain is usually worse early in the morning.

- Sinusitis -- Face pain caused by an inflamed sinus should come during or after an upper respiratory problem. This pain should also get better, or worse, based on the position of the head. For example, the frontal sinuses should be relieved by standing or sitting, and worse when lying down. This pain should also be worse at night with improvement as the day progresses. Pain from sinus inflammation may radiate to the inside of the mouth but will typically only be present over the inflamed sinus. Here is a picture of where the different sinuses are located for better reference.

- Conditions to Consider in the Younger Patient -- According to the International Headache Society (HIS) there are two classifications of trigeminal neuralgia: classical and symptomatic. The most common classification is the classical. In this presentation, an underlying cause cannot be identified. This form of trigeminal neuralgia also presents later in life. The symptomatic classification of TN will demonstrate neurological loss and is attributed to an underlying lesion. Most often, this group will also occur to people under the age of 50. There are a few conditions that should be considered, such as: multiple sclerosis, trigeminal neuroma, and acoustic neuroma. These conditions are rare and can only be determined through specialized testing.

Making a Case for Chiropractic Management

A case report done in 2010 showed an improvement in the intensity and frequency of pain associated with trigeminal neuralgia in a 68 year-old woman after an initial treatment period, followed by 18 months of supportive care. After the initial course of treatment, the patient reported that her pain was reduced to "minimal", and had not returned to her pre-treatment level of pain. In all the cases involving chiropractic care in the treatment of trigeminal neuralgia, patients experienced quick relief of pain following a long duration of symptoms prior to care. Symptoms returned with non-compliance to care, and relief came again with the return of chiropractic care. Sustained improvement did happen when the patients were compliant with supportive care. If you have trigeminal neuralgia, or know someone who does, a chiropractor is a great natural form of treatment. If you have any questions at all, do not hesitate to call our office and set up a free consultation.

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