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Trigeminal Neuralgia

Pain | February 3, 2017 | Author: Naturopath

Nervous system, neurovascular, Pain

Trigeminal Neuralgia

Many take for granted the ability to perform regular daily activities of living such as grooming, eating, or even social activities such as talking or smiling. For some, these otherwise mundane activities that involve and affect the face may be a cause for misery brought on by the excruciating pain of Trigeminal Neuralgia.

Also known as tic douloureux, the prevalence of Trigeminal Neuralgia (TN) has rise significantly over the years, being estimated today at approximately 1.5 cases per 10, 000 population.

The Trigeminal Nerve and Trigeminal Neuralgia

Trigeminal Neuralgia is so named because it has its effects from or at a cranial nerve known as the trigeminal nerve, the largest of the cranial nerves. It exits at a part of the cranial bone known as the mid-pons and is divided into two root branches; the smaller motor root and the larger sensory root. It is the smaller, motor root that sends signals for movement to facial tissues and contains nerve fibers that are responsible for communicating sensations of pain.

The trigeminal nerve has three divisions that are directly connected to the main roots of the nerve and connect these to the facial tissue that the nerve supplies, namely; the ophthalmic, maxillary and mandibular divisions. Hence, the prefix “tri” means “three” and the suffix “germinal’ refers to the fact that there are two or more connected to the same stem.

Pathophysiology

While the exact pathophysiology of trigeminal neuralgia is somewhat unclear, it is believed that the etiology may be central, peripheral, or even both. The key to understanding this conditions pathophysiology may be the fact that the trigeminal nerve’s main function is that of sensory perception, mainly supplied to various facial tissues. This means that the trigeminal nerve is able to cause pain.

In up to 85 percent of TN cases, there is usually no clear structured lesion present to indicate the etiology of the condition. However, it is thought that in most of these cases, the loops of some veins and/or arteries suffer compression where the trigeminal nerve itself enters into the pons, thus damaging the protective covering of the nerve’s myelin sheath (Demyelination). This may alter the very pain mechanisms of the primary afferent fibers that promote nociception (pain).

Causes

While the pathophysiological discussions of trigeminal neuralgia attempt to explain the mechanisms through which the condition results, the etiology or ‘cause’ attempts in turn to explain the triggers for hose mechanisms. To explain the causes of trigeminal neuralgia, we need to differentiate between the 2 types of the condition:

Classic 

This is considered idiopathic, meaning that it is of unknown origin or cause. These include cases in which a normal artery is in contact with the trigeminal nerve itself.

Symptomatic

This form can be quite multifactorial. Commonly, an abnormal course of the superior cerebellar artery is cited as a cause. Less commonly, some underlying medical condition causing lesions may lead to the pain syndrome as in trigeminal neuralgia. Legions include, but are not limited to:

  • Aneurysms
  • Tumors
  • Chronic meningeal inflammation

In some cases, multiple sclerosis may cause the demyelination that result in nerve irritation and subsequently, trigeminal neuralgia pain.

Signs and symptoms

Patients with TN often report attacks of sharp, stabbing pain, usually felt on one side of the face.

The symptoms characteristically present on the right side of the face, but may also affect the left side of the face.

The frequency of these attacks vary from patient to patient, with some patients reporting experiencing just one attack per day, to some patients reporting experiencing more than 12 attacks per hour, throughout the day.
 

Pains are triggered by activities or actions that involve or the face or tissues of the face such as:

  • Chewing, talking or smiling
  • Drinking fluids of extreme temperatures (hot or cold)
  • Touching the face
  • Brushing teeth
  • Shaving
  • Blowing the nose
  • Cold air hitting onto the face from an open car window or blowing wind.

Common features of TN are:

  • Ability to localize the pain precisely
  • Pain that shoots down from the corner of the mouth to the angle of the jaw
  • Pain that jolts down from the upper lip or canine teeth to the eye or eyebrow, without affecting the actual orbit itself
  • Pain that involves the ophthalmic branch of the facial nerve

Natural therapies

Treatment of TN using natural therapies involves taking a holistic approach to treat not only the symptoms of pain but to make an attempt to treat the very cause.

Vitamin b12. This vitamin is cornerstone to overall healthy nerve function. Vitamin B12 is naturally sourced from meat products; however there are various factors that may contribute to a deficiency in the vitamin such as following a vegan or vegetarian diet, smoking and drinking, among other factors. Supplements to fulfill the daily requirement of vitamin B12 can be prescribed. 

Omega 3. This is an essential fatty acid that helps to strengthen the nerves and ease inflammation. Omega 3 is naturally found in foods such as Salmon and other fatty fish, olives, coconut oil and wallnuts. Since it is quite difficult to source an adequate amount of Omega 3 fatty acids through diet alone, taking an Omega 3 supplement such as fish or krill oil may reduce symptoms of neurological dysfunction. 

Magnesium. People may have a magnesium deficiency due to stress,dietary deficiencies or medications such as diuretics. Magnesium is essential in aiding optimal nervous system function and muscle relation, which will help ease symptoms. 

Zinc. Zinc helps the nervous system in many various ways, including the maintenance of the nervous system. Health conditions such as leaky gut syndrome can lead to inefficient absorption of this mineral, resulting in a deficiency. Besides supplementation, eating foods that are rich in zinc including grains, legumes, shell foods and animal products. 

Aromatherapy and essential oils

Aromatherapy is a form of holistic therapy that uses essential oils that heal throuth the sense of smell. They can help ease muscular tension, nervous stress and relieve pain, including neurological pain.  Oils that may be useful include:

  • Peppermint oil
  • ​Wintergreen oil
  • Clove oil
  • Rosemary oil
  • Helichrysum halicum

Chiropractic.  A chiropractitioner specializes in using hands to maneuver the skeletal system in such a way as to realign the body. This can help ease TN pain.

Acupuncture. Helps to relieve various kinds of pain through the use of specialized needles that target the nerves and reinforces harmonious energy flows. This tradition Chinese practice is an FDA approved pain relief method.

Diet. Adjusting the diet to incorporate healthy dietary habits will ensure overall improvement of health, including nervous system function. Specific dietary guidelines to follow include:

  • Low saturated fat diet
  • Grains such as rice, pasta and whole breads
  • Legumes that are high in proteins and zinc such as beans
  • Seafood is a good source of healthy fats such as Omega 3
  • Fruit and vegetable

Herbs

Herbs help to manage the pain of trigeminal neuralgia through topical application or consumption in supplement form, depending on the indication. The best herbs for trigeminal neuralgia pain are the following:

Cayenne Pepper. Applying of capsaicin cream topically will help to ease pain. It is available over the counter.

Valerian. Valerian herb is a nervine that acts to strengthen the nervous system as a whole.

Rosemary. Rosemary treats various nervous system ailments such as anxiety, insomnia, fear and migraines. It is ideal to treat nervous system dysfunctions.

Shao Yao Gan Cao Tang. It is a traditional Chinese herb that is made by combining peony and licorice herbs. It is ideal for treating and calming spasmodic and jolting pains in the face.

Qing Shan Juan Tang Tong. This is an ideal Chinese herb that specializes in the treatment of facial pain.

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There is currently no known cure for trigeminal neuralgia and treatment is focused mainly on the management of pain symptoms. It is advisable to consult with a medical professional before taking any herbs or undertaking any natural therapies for treating trigeminal neuralgia. This is especially true if there is suspicion or the known diagnosis of aneurysms, tumors, multiple sclerosis or any other underlying medical condition.

References

Longo DL, et al., eds. Trigeminal neuralgia, Bell's palsy, and other cranial nerve disorders. In: Harrison's Principles of Internal Medicine. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://accessmedicine.com. Accessed May 24, 2015.

Trigeminal neuralgia fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/detail_trigeminal_neuralgia.htm. Accessed May 25, 2015.

Bajwa ZH, et al. Trigeminal neuralgia. http://www.uptodate.com/home. Accessed May 24, 2015.

Riggs EA. Decision Support System. Mayo Clinic, Rochester, Minn. April 17, 2015.

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