Trigeminal Neuralgia treatment – neurovascular conflicts

Prolotherapy Knee articular cartilage repair without surgery

Ross Hauser, MD

Trigeminal neuralgia is a very painful condition where pain radiates into the face and jaw. The trigeminal nerve carries pain, feeling and sensation from the brain to the skin of the face. In the case of trigeminal neuralgia, most medical professionals cannot find the cause for why this pain started. This is borne out by the definition of trigeminal neuralgia. Trigeminal neuralgia means that there is nerve pain in the nerve distribution of the trigeminal nerve. It actually does not tell a person what is causing the condition.  When a physician and a patient believes that a nerve is getting compressed, it is easy to see why a surgery would be recommended. Unfortunately, when cervical neck instability is the cause of the neuralgia, the surgery does not help relieve the pain.

Cervical instability can also be responsible for almost all painful neuralgias of the head and face including occipital and trigeminal neuralgia,  as well as structural headaches including tension, migraines and cluster.

Before you continue with this article, do you have questions about Trigeminal Neuralgia treatment? You can get help and information from our Caring Medical Staff.

New research from university and medical researchers in India published in the October-December 2017 edition of the Asian journal of neurosurgery reviewed current Trigeminal Neuralgia treatment.(1) Here are highlights of their research:

The question is again, if the surgery is so successful, why subject patients to this type of drug regiment as a means to prolong the need for surgery?

The Indian researchers gave an exhaustive and detailed study on how to help patients with Trigeminal Neuralgia. Like many other conditions we see, surgery is thought to be a good option, but only after years of pharmacological pain management. Why not seek something more curative?

The difficulty in diagnosis and the problems of too much treatment or inappropropriate treatment was recently discussed in research by doctors in Germany at the Göttingen University Medical Center. Here they looked at oral problems.

The same study looked at the surgical treatment options:

These are very difficult procedures and invasive procedures to get only 2 out of 3 patients pain-free. One out of three continues on with their pain.

Trigeminal Nerve

Treating Trigeminal Neuralgia by examining ligaments

For people suffering with this condition and not getting help from the conventional routes, an examination of cervical ligament instability is an option that should be considered.

The ligaments, muscles and tendons in the suboccipital region (back of head) cause an irritation of some autonomic nerves in the neck. These autonomic nerves (stellate ganglion etc.) then cause the severe lancinating pain that these patients often experience. The referral pain can be significant and simulate the pain of trigeminal neuralgia.

If the person is tender in the neck or back of the head to manual palpation, then there is a good chance that Prolotherapy will be the treatment that finally gets rid of their trigeminal neuralgia pain.

Trigeminal neuralgia pain is typically on one side and very, very significant. Sometimes the TMJ needs to be treated, and occasionally a nerve blocks into the trigeminal nerve. Once the TMJ or neck ligaments are tightened with Prolotherapy, the facial pain remits. In our offices, most patients would need to come every 3 to 4 weeks and receive four to seven visits.

Once the ligament laxity has been relieved, so is the autonomic nerve irritation. The net result is a pain-free, happier person.

Case of trigeminal neuralgia helped with Prolotherapy

As discussed, there is often undiagnosed ligament laxity either in the neck or the temporomandibular joint (TMJ) causing referral pain patterns that create symptoms of trigeminal neuralgia.

Previous treatments included six root canals and acupuncture yet her pain remained. A friend referred her to Caring Medical for Prolotherapy.

During the patient’s first visit she explained that her greatest pain came with eating, talking and smiling. Often pain would shoot from her lips to her ears.

Dr. Hauser examined the patient’s TMJ and face and determined she would be a good candidate.

One month later the patient returned and reported that her face was no longer painful to the touch and she no longer had shooting pain from her lips to her ear. She had some pain with talking and eating but was hopeful that the next scheduled treatments would alleviate these problems.

Prolotherapy for Trigeminal Neuralgia

In the Journal of Prolotherapy, our colleagues Eileen Conaway, DO and Brian Browning, DO describe a case history of a  63 year old Hispanic female.(4)

The patient was referred to their office for osteopathic evaluation and treatment for chronic neck and head pain. Among other somatic complaints, her history revealed 13 years of burning pain on the left side of the forehead and scalp.

Figure 1. Supraorbital nerve is a branch of the V1 ophthalmic division of the trigeminal cranial nerve (CN V). It passes through the supraorbital foramen to innervate the forehead, extending to the mid scalp.

The pattern of her pain followed the V1 nerve path (see illustration to left). The pain began after undergoing two neurosurgical procedures to repair a cerebral aneurysm.

She reported pain even to light touch of the affected areas of the scalp and was often unable to brush her hair due to the pain it caused. She had tried over the counter analgesics and tramadol-acetaminophen with little relief. She was initially treated with osteopathic manipulation which provided symptomatic relief for a few hours. She was hesitant to try additional medications due to their side effect profile as she also suffered from hypertension, dyslipidemia, and non-insulin dependent diabetes.

She was treated with Neural Prolotherapy on three occasions. The first two injections were one week apart, and the third was 12 weeks later.

After three treatments with Neural Prolotherapy she experienced complete resolution of her V1 branch trigeminal neuralgia. After one year, the patient reports the ability to brush her hair without pain and overall improvement in quality of life and her ability to perform activities of daily living.

Also detailed in the Journal of Prolotherapy is a case history described by Alan Itkin, PA-C, MS-4 in Treatment of Trigeminal Neuralgia Utilizing Neural Prolotherapy: A Case Report.(5)

Physical:
Examination showed no focal neurologic deficits. There were dysesthesias (abnormal sensation) and allodynia (abnormal and heightened sense of pain) along the maxillary and ophthalmic branches of the trigeminal nerve.

The patient was treated utilizing a neural prolotherapy technique. Approximately 15 injections were provided to the distribution of the 3 involved branches of the trigeminal nerve.

After the procedure, the patient was instructed to utilize the cotton swab to try and reproduce his symptoms. The patient was unable to reproduce any of the pain and sensitivity that was present prior to the procedure. The patient was observed in the clinic for 15 minutes and had no “tics” from trigeminal neuralgia. The patient was instructed to follow up in 1 week however the patient did not return until 6 months later.

Six month follow up:
At this visit, the patient reported that the neural prolotherapy treatment provided him with 5 months of complete resolution of his symptoms. He stated that his symptoms only returned after hitting his head when exiting his car. His complaints at this time involved severe, sharp stabbing pain in the right forehead, right eyeball, periorbital region and right temple. He complained of pain when getting a haircut, he found that just simply touching his hair and scalp caused him severe pain.

Treatment #2:
The patient was given a second treatment of neural prolotherapy along the course of the trigeminal nerve. The same technique as the first treatment was utilized. The patient again noted immediate complete resolution of his pain.

Do you have questions about Trigeminal Neuralgia treatment? You can get help and information from our Caring Medical Staff.

1 Yadav YR, Nishtha Y, Sonjjay P, Vijay P, Shailendra R, Yatin K. Trigeminal neuralgia. Asian Journal of Neurosurgery. 2017 Oct;12(4):585.

2 Borucki L, Szyfter W, Wrobel M, Sosnowski P. Neurovascular conflicts. Otolaryngologia polska= The Polish otolaryngology. 2006;60(6):809-15.

3 von Eckardstein KL, Keil M, Rohde V. Unnecessary dental procedures as a consequence of trigeminal neuralgia. Neurosurg Rev. 2015 Apr;38(2):355-60; discussion 360. doi: 10.1007/s10143-014-0591-1. Epub 2014 Nov 25.

4 Conaway E, Browning B, Neural Prolotherapy for Neuralgia. Journal of Prolotherapy. 2014;6:e928-e931.

5 Itkin A. Treatment of Trigeminal Neuralgia Utilizing Neural Prolotherapy: A Case Report. Journal of Prolotherapy. 2016;8:e961-e965.

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