Trigeminal Neuralagia

[crackers]

Has anybody had trigeminal neurologia or epilepsy?

 

Ever taken tegretol?

 

Ever tried to climb on it?

 

 

[archenemy]

I have taken tegretol. I experienced almost no side effects (much better than previous anti-convulsants). I had mild ataxia, and would just work a little lighter as a result.

 

But DO NOT risk drinking alcohol, not even the night before, on it when planning to climb.

 

[crackers]

Ah ha!

 

I drank the night before I took some tegretol and it was like a very very screwed up version of reality minus balance and coordination.

[G-spotter]

Was the drink "shaken, not stirred"?

[AlpineK]

I don't know about Trig... but the doctors don't want me drinking because I'm at risk of having another seizure. I'd sure like a beer, but it isn't worth another trip to the hospital.

 

Just set drinking as a goal for the future.

Edited February 21, 2007 by AlpineK

[G-spotter]

What about LSD, can you trip?

[archenemy]

Actually, yes.

 

For some strange reason, it's the alcohol that doesn't go with this med. And for some stranger reason, the docs don't tell you that. Maybe they haven't tested for the interaction yet or maybe they just don't think many people react that way; I really don't know.

[AlpineK]

What about LSD, can you trip?

 

That brings back some fun times, but I've kind of lost interest in that over time.

[crackers]

The docs tell you about grapefruit juice but not that drinking a beer is a bad idea...

 

I wouldn't want to take this crap and anything else at the same time. It would be a waste of anything else.

 

I've supposedly got neurologia not epilepsy, but from the warnings, this drug is pretty serious.

[Sherri]

Is it the side effects of the tegretol you are concerned about in your climbing activities? Or the potential for seizures?

 

I know a climber who takes anti-seizure meds with no adverse climbing-related effects. Not Tegretol, though--had a bad ride on that horse.

 

Ditto on A.E.'s advice about steering way clear of the alcohol, though. Not only do they mess with the meds effectiveness, but for some forms of epilepsy(JME in particular) alcohol lowers the seizure threshold...

 

Bad news for more than just climbing. skull

[archenemy]

It's not the potential for seizure, Neuroglia is not a seizure disorder. But the associated pain would drive anyone crazy and make it worth trying a drug like Tegretol. Especially if climbing is one of the things that trigger a painful episode.

 

Good luck Crackers--and remember that if they have not done so already, be sure they check for MS. Not to scare you, but sometimes that is misdiagnosed as Neuroglia (I am sure they already checked this from your scan--but it's good to ask). Best of luck to you and my heart goes out to you.

[crackers]

Thanks archenemy.

 

For me this has nothing to do with seizures.

 

Neurologia is intense nerve pain and they give you anti-seizure / nerve blocker meds. Imagine having an electric fence running from your nose to your ear, inside of your head.

 

The tegretol is better than what I was trying before. Neurotin put me to sleep and when I wasn't sleeping I couldn't think. I applied for the job of the village idiot, and was told I didn't qualify...wasn't up to standard.

 

But when I started on the tegretol, i had no coordination and couldn't imagine being trusted with a belay device, let alone the sharp end. However, it seems that was due to alcohol interactions.

 

Negative on MS Thanks for recommending that I check it though.

[hemp22]

hey Graham - good to hear that you don't have a brain tumor at least.

I have a friend who has to be on medication that doesn't let him drink alcohol, and for him it's a sacrifice that's definitely worth making to keep him climbing a lot...

So, just take it easy on the sauce before doing any leading, eh?

we need you to stay in good health so that you can keep making packs - i'm gonna be pack shopping again soon.

(by the way, whatever became of the clamshell-type crag pack idea? are you still pursuing that, or is the new 40L going to be the way to go for a cragging pack?)

[archenemy]

I applied for the job of the village idiot, and was told I didn't qualify...wasn't up to standard.

Yeah, I set the bar pretty high on that one. I even won employee of the month!

 

Best of luck to you!

[sobo]

...I applied for the job of the village idiot, and was told I didn't qualify...

 

I heard that job has been filled for the past 6-1/2 years now. But keep your resume' up to date; it'll be opening up again next Fall.

 

Sorry, this isn't Spray, is it?

[layton]

try getting a cervical adjustment by a good chiropractor!

[archenemy]

I have had great success with chiropractic adjustment for various problems. However, this is one situation where I would be very hesitant to agree with this recommendation. I have no medical training, but I do have first had experience with much of what we're talking about here and that is my $0.02. But to each his own, each person is different and the body is an incredibly complex thing...

[crackers]

Layton, after most chiro's have seen the xrays of my neck they won't touch me. And I don't trust the one's who will on the whole.

 

I am going to get some acupuncture. But like Arch was saying, this is not something that I feel like playing around with...

 

Hey ArchE, did you ever drink a beer when you were on Tegretol?

[archenemy]

Yes, and paid for it dearly.

[layton]

I recommended chiropractic adjustments, but obviously only if there are no contraindication to it. Seems like there are. With trigeminal neuralgia, your options are fairly limited to drugs and or surgery. As far as I know, most people would be willing to try anything to avoid at least the surgery part. No chiropractor should claim that it will help, but it is worth a try if the rest of your history and imaging is clean...call it experimental conservative treatment. Massage, PT, or acupuncture could be other alternatives. I'd still give it a shot if there isn't evidence of instability, infection, tumor, basilar impression...basically anything a high velocity, low amplitude impulse would fracture, dislocate, or jar something loose into your system. I assumed you were clear since you are also a climber and there's a whole lot more dangerous neck movement involved with that (and looking back to change lanes!).

 

I hope you find something that helps and the cure isn't worse than the disease.

[layton]

Okay, the follow isn't my opinion as far as the "One Cause, One Correction" standpoint...that's a bit far fetched. But it is an interesting article.

 

Parkinson's Disease, Meniere's Syndrome, Trigeminal Neuralgia and Bell's Palsy: One Cause, One Correction

by Michael T. Burcon, DC

 

Abstract

 

I currently have 16 Meniere's syndrome, two Parkinson's disease, two Trigeminal neuralgia and two Bell's palsy patients under my care. They all have one thing in common: The atlas vertebra is subluxated posteriorly, which has caused the head to project forward, taking away the healthy curve of the neck.

 

In each patient, the pelvis has twisted to take pressure off the important nerves in the upper neck and brainstem, causing one leg to appear shorter than the other; normal lumbar curvature is compromised; and finally, if not specifically adjusted, the patient compensates by developing an exaggerated curve in the thoracic spine.

 

I hypothesize that in each patient, kink(s) in the neck inhibited the normal flow of cerebrospinal fluid out of the skull and down the spine; this created excess pressure in the fourth ventricle, causing abnormal function of some of the structures in the midbrain. It also inhibited the flow of blood into the occipital area of the brain by kinking one of the vertebral arteries. Additionally, I suggest that the posterior atlas irritated the anterolateral aspect of the brainstem, irritating any combination of the bottom seven cranial nerves.

 

All 22 patients improved dramatically after one or two adjustments under cervical-specific chiropractic care. When the atlas returns to juxtaposition, the spinal cord relaxes and actually positions itself lower within the spinal column.

 

Key Terms: Parkinson's disease; Meniere's syndrome; Trigeminal neuralgia; Bell's palsy, posterior atlas subluxation; specific adjustment.

 

Introduction

 

Parkinson's disease (PD, Paralysis Agitans, or "Shaking Palsy") is an idiopathic, slowly progressive, degenerative central nervous system (CNS) disorder with four characteristic features: slowness and poverty of movement; muscular rigidity; resting tremor; and postural instability. Parkinson's disease is the fourth-most-common neurodegenerative disease afflicting the elderly: It affects about 1 percent of the population over 65 years old, compared with 0.4 percent of the population under 40 years old. The mean age of onset is about 57 years of age. Onset in childhood or adolescence (juvenile Parkinsonism) also occurs.1

 

The etiology and pathophysiology of primary Parkinsonism is loss of the pigmented neurons of the substantia nigra, locus ceruleus and other brainstem dopaminergic cell groups. The loss of substantia nigra neurons, which project to the caudate nucleus and putamen, results in depletion of the neurotransmitter dopamine in these areas.1

 

For 50 percent to 80 percent of patients with PD, the disease begins insidiously with a resting 4- to 8-Hz "pill-rolling" tremor of one hand. The tremor is maximal at rest; diminishes during movement; is absent during sleep; and is enhanced by emotional tension or fatigue. The hands, arms and legs usually are most affected, in that order. The jaw, tongue, forehead and eyelids also may be involved, although the voice is not affected. Many patients display only rigidity and never manifest tremor. Progressive rigidity, slowness and poverty of movement (bradykinesia) and difficulty in initiating movement (akinesia) follow.1

 

The face becomes mask-like and open-mouthed, with diminished blinking. Posture becomes stooped. Patients find it difficult to start walking; the gait becomes a shuffle with short steps and the arms are held flexed to the waist and fail to wing with stride. The steps may inadvertently quicken, and the patient may break into a run to keep from falling ("festination"). On examination, passive movement of the limbs is met with plastic, unvarying lead-pipe rigidity; superimposed tremor bursts may give ratchet-like cogwheel quality.1

 

The sensory examination usually is normal. Signs of autonomic nervous system function may be seen. Muscle strength usually is normal. Dementia occurs in about 50 percent of patients; depression also is common.1

 

The standard medical treatment for PD has been the administration of the drug Sinemet, which combines Levodopa (a short-acting drug that enters the brain and is converted into dopamine) and Carbidopa (which enhances Levodopa's action in the brain). Several neurosurgical techniques also exist, including thalamotomy (destruction of the ventral thalamus to control tremor); pallidotomy (destruction of the posterior ventral globus pallidus to control hyperkinetic symptoms); and deep- brain stimulation (electrode implantation for patient-controlled stimulation of the thalamus to control tremor). While medication and surgery may control symptoms temporarily, neither stops or reverses the progressive degeneration of the substantia nigra.2

 

B.J. Palmer reported the use of upper-cervical chiropractic care with PD patients as early as 1934. In his writings, he referred to patients with shaking palsy and listed improvement or correction of symptoms such as tremor; shaking; muscle cramps and/or contracture; joint stiffness; fatigue; lack of coordination; difficulty walking, or inability to walk; numbness; pain; and muscle weakness. His chiropractic care included paraspinal thermal scanning using a neurocalometer (NCM); a cervical radiographic series to analyze the upper-cervical spine; and a specific upper-cervical adjustment performed by hand. Erin L. Elster, DC, found no other references for the chiropractic management of PD patients, prior to her study on 10 PD patients in the year 2000, utilizing modern upper-cervical chiropractic care.2

 

Three-month re-evaluations revealed substantial improvement in subjective and objective findings in six of the 10 patients, and mild improvement in two patients. The findings of the other two patients, both over age 65, remained unchanged. According to the Unified Parkinson's Disease Rating Scale (UPDRS), six of 10 patients showed overall improvement ranging from 21 percent to 43 percent after three months of upper-cervical chiropractic care.2

 

Meniere's syndrome is characterized by vertigo or dizziness, and some combination of four associated symptoms: nausea, inner-ear pressure, low-frequency hearing loss and tinnitus. The cause of Meniere's syndrome is unknown and the pathology is poorly understood.1 The attacks of vertigo appear suddenly, last from a few to 24 hours, then subside gradually. The attacks are associated with nausea and vomiting. The patient may feel a recurrent feeling of fullness in the affected ear, and the hearing in that ear tends to fluctuate, but worsens over the years. Tinnitus may be constant or intermittent.

 

Trigeminal neuralgia (Tic Douloureux) is a disorder of the trigeminal nerve producing bouts of severe, lancinating pain lasting seconds to minutes in the distribution of one or more of its sensory divisions, most often the mandibular and/or maxillary. The cause is uncertain. Recently, surgery at autopsy suggests that this condition is essentially a compressive neuropathy of the brainstem.1

 

Bell's palsy is a unilateral facial paralysis of sudden onset and unknown cause. Pain behind the ear may precede the facial weakness that develops within hours, sometimes to complete paralysis. The mechanism is presumed to involve swelling and compression of the facial nerve. (1)

 

In addition to the upper-cervical chiropractic care based on the research of B.J. Palmer, with the assistance of Lyle Sherman, DC (later refined by William G. Blair, DC), I have added the lower-cervical research and adjustment utilized by Walter Vern Pierce, DC, into a technique that I refer to as "cervical-specific chiropractic."3

 

In my previous research with cases involving brainstem irritation (Meniere's disease, Trigeminal neuralgia and Bell's palsy), I discovered that the main cause was cervical trauma. The trauma forced the top cervical vertebra (atlas) to subluxate posteriorly, with laterality on the opposite side of the patient's symptoms (i.e., if the patient had fullness and gradual loss of hearing in the right ear, the atlas listing would be posterior and inferior on the left [PIL]). These same findings are substantiated by my Parkinson's research.4

 

Methods

 

My technique is based on the work of B.J. Palmer, as developed at his research clinic at Palmer Chiropractic College in Davenport, Iowa, from the early 1930s until his death in 1961.5-7 I have also studied the vertebral subluxation pattern work of B.J.'s clinic director, Lyle Sherman, DC, for whom Sherman College of Straight Chiropractic, is named.8

 

A detailed case history is taken on the first visit, followed by a spinal examination. First, the patient's cervical spine is graphed, using an advancement of the dual-probed NCM first used by B.J.9 Next, cervical motion palpation is performed, noting any aberrant motion of the vertebrae.

 

Detailed leg checks are performed on each patient visit, utilizing the work of J. Clay Thompson, DC, and Clarence Prill, DC.10 With the patient prone, an apparent short leg often is noted. The patient is instructed to turn his or her head to the right. If the short leg becomes more balanced, a right cervical syndrome is listed. The patient is then instructed to turn the head to the left. If the short leg becomes more balanced, a left cervical syndrome is listed. If both movements lengthen the short leg, a bilateral cervical syndrome is listed.

 

Modified Prill leg checks are used to determine the major cervical subluxation. The top four cervical vertebrae are tested as instructed by the Blair Chiropractic Society. They are referred to as "modified" because Dr. Prill uses the arms to detect imbalances, whereas Blair chiropractors use the legs. Patrick J. Sweeney, DC, and I refined the tests for the bottom three cervical vertebrae.

 

Atlas (C1) is tested by instructing the patient to "gently and steadily raise both feet." The doctor resists by holding the heels of the feet with his open hands. If the short leg stays short or becomes shorter, it is listed as a positive test for nerve interference at the level of C1. It is postulated that the flexion and extension of the leg correlates to the flexion and extension of the head, 50 percent of which occurs at the atlas.

 

Axis (C2) is tested by instructing the patient to "gently and steadily pull the feet together," while the doctor resists foot rotation. The rotation of the feet correlates to the rotation of the head, 50 percent of which occurs at axis. The third cervical vertebra is tested by having the patient pull his or her legs together; C4 is tested by having the patient pull the legs apart.

 

The fifth cervical is tested by having the patient raise both arms while the doctor holds the biceps. The patient raises his or her arms while the doctor holds brachioradialis muscles to test C6, and pushes the arms down while the doctor holds the triceps to test C7.

 

Three cervical X-rays are then taken to get listings for the segments that test positive and to check for contraindications to adjusting: lateral, A-P open-mouth and nasium. The lateral is used to check for a posterior kink in the lower cervicals; the A-P is used to check for translation, usually the result of a "T-bone" automobile accident; and the nasium is used to determine the atlas listing, utilizing the Blair theory of upper-cervical subluxation. There are only four atlas listings in Blair work. Dr. Blair's research demonstrated that there is no pure lateral movement at C1. The atlas will tend to articulate properly on one condyle while partially slipping off from the other.11

 

If the atlas subluxates anteriorly, it must move superiorly, due to the "rocker" shape of the articulation. If it tracks on the left, the atlas will show an overlap on the right articulation on the nasium. This is listed as an "ASR" (anterior and superior on the left). If it tracks on the right, it will overlap on the left ("ASL"). Anterior listings are more common and tend to be less symptomatic than posterior listings.

 

Typically, a posterior atlas subluxation is the result of head, neck or upper-back trauma. If the atlas subluxates posteriorly, it must also move inferiorly. If it tracks on the right, it will underlap on the left. This listing is "PIR" (posterior and inferior on the right). If it tracks on the left, it underlaps on the right, and is listed as "PIL."

 

I postulate that one reason a patient can have a problem on the opposite side of his or her posterior listing is that this is the side at which the atlas is not articulating properly with the occiput. Over time, this can cause irritation in that area, leading to inflammation and eventually scarring. I feel the vertebral artery often is kinked on that side, adding to the problem. One thing I'll never forget from cadaver dissection is how every structure seemed to be fighting for its space within the human body. This was especially true at the surprisingly small junctions between the skull and the upper cervicals, and the junction between the base of the neck and the thorax.

 

chiropractic

 

No adjustment is given on the first visit. A pattern of subluxation must be established on the second visit; patients are checked on subsequent visits. If the pattern has not returned, no adjustment is given. The atlas is always the first segment adjusted. The technique used varies, depending on radiographic analysis. If the major misalignment is translation, a side-posture toggle-recoil technique is used ("hole in one"). If the major component of the subluxation is posteriority, a prone position is used. A drop mechanism is used on all adjustments.

 

If, after the atlas holds, positive tests persist in other cervical segments, those vertebrae are adjusted. Again, both side-posture and prone positions are used on the lower cervicals. Patients rest for 15 minutes after every adjustment, then are checked. Patients are released only after their legs present balanced.

 

The UPDRS is used on every visit to graph any improvement in symptoms. Thirty-one separate areas are graded, covering mentation, behavior and mood, activities of daily living and motor examination. Each area is graded 0 for no problem; 1 for a mild problem; 2 for a moderate problem; 3 for a severe problem; or 4 for a persistent problem.

 

Case Reports

 

Case #1

 

History: A 74-year-old retired male truck driver diagnosed with Parkinson's in 1994. He broke his right collarbone and left wrist falling off a ladder (about eight feet) onto the right side of his head in 1991. He was diagnosed with Meniere's syndrome in 1985 and Bell's palsy in 1983. He suffered a low-speed auto accident in 1974.

 

Medications included Permax and Singmet. He plays golf occasionally and bowls regularly.

 

Examination: Patient presented with tremor of left hand and jaw and reported restlessness and inability to sleep. He was disappointed because he and his wife could not go to Florida this winter, which they had been doing for several years. UPDRS totaled 44 points; inability to rise out of a chair was the highest score (3).

 

Thermograph reading was 3¡ cold at the bottom of the cervicals, increasing to 5¡ at the top. Patient had a three-quarter-inch short left leg; half-inch right cervical syndrome (RCS); and positive modified Prill tests on C1, C2 and C5.

 

Lateral X-ray revealed a severe kink at C4/5, AP showed the axis to be body-left, and nasium determined the atlas to be PIR.

 

Intervention and Outcome: Patient presented with a pattern of subluxation on the second visit. Atlas was adjusted with patient in prone position with the chin tucked toward the chest. Knife-edge contact was made lateral to the spinous process of the axis with the doctor standing on the right side of the table. Line of drive was mostly posterior to anterior (P-A), somewhat inferior to superior I-S. Patient's hand tremor ceased immediately with the adjustment.

 

After a 15-minute rest, there still was no evidence of tremor, which was noted as constant on his first visit. I had the patient attempt to get out of a chair without assistance - he could not. I repeated the leg checks; the only positive test was for C5. I challenged the segment on the right, and the short leg went shorter. The challenge while standing on the left balanced the legs.

 

I did a Pierce technique adjustment on C5, standing on the left side of the table, using a knife-edge contact below the spinous process. The adjustment was mostly P-A, some I-S, using the drop mechanism. Again, the patient was allowed to rest for 15 minutes. There still was no tremor, and this time, he was able to lift himself out of a chair without help.

 

Case #2

 

History: A 21-year-old female college student employed as a receptionist in a medical office. She had been taking Tegretol and Neurotin for the previous year after being diagnosed with Trigeminal neuralgia. She was doing poorly in school, which she attributed to the effects of medication use.

 

She was diagnosed with scoliosis at age 9. Her mother reported that her delivery was difficult. She denied being in any auto accidents, but she did play contact sports in high school.

 

Examination: Leg checks showed a three-quarter-inch right pelvic negative (RPN), one-inch bilateral cervical syndrome, and positive C1 and C5 Prill tests. She had limited range of motion on bilateral cervical rotation and left-lateral cervical flexion.

 

Her left ear was noticeably higher than her right. X-ray showed a PIL atlas, body left axis and posterior C5.

 

Intervention and Outcome: Subjective findings included lightheadedness from medications; stabbing, burning and throbbing right maxillary pain; and low-back pain. I adjusted her atlas PIL using the side-posture toggle-recoil technique. She reported dizziness on her next visit. I adjusted C5 after it tested positive for nerve interference.

 

On her third visit, I adjusted her sacrum; on her fourth visit, she presented balanced and pain-free and was not adjusted. She discontinued her medications and held her atlas adjustment for eight months. She lost her adjustment when she received a neck massage. Her second atlas adjustment has held for 16 months.

 

Case #3

 

History: A 46-year-old married Caucasian female diagnosed with Trigeminal neuralgia (left mandibular); Sjogren's syndrome; irritable bowel syndrome; erythema multiforme; allergies; and Raynaud's phenomon. She reported whiplash stemming from a rear-end automobile collision in 1998.

 

Examination: A half-inch right pelvic positive (RPP) and positive Prill tests for C1 and C5 were noted, as was limited range of motion for left lateral cervical flexion. X-rays showed evidence of atlas PIR and C5 posterior subluxations. She was hoarse, which was later diagnosed as a staff infection of her lungs.

 

Intervention and Outcome: The atlas and C5 were adjusted on the first visit. The fifth cervical and fifth lumbar were adjusted on the second visit. The axis and sacrum were adjusted on the third visit, and C5 and the sacrum on the fourth. She presented balanced and pain-free on the fifth visit, after two months of specific care. She is still holding her balance after two months.

 

Case #4

 

History: A 78-year-old male who woke up with right facial paralysis. He was an existing patient being treated for cervicalgia and severe motion restriction of the cervicals. His chief complaint was that he could no longer look over his shoulder to back out of his driveway.

 

He was also experiencing low-back pain and some problems with his right shoulder and right hip. He was being medicated for high blood pressure and had a history of a minor stroke.

 

Examination: One-inch LPP with positive Prill C5 and C1 tests were noted. X-rays showed a PIL atlas and posterior fifth and sixth cervicals. Apparent stenosis of the entire spine was noted.

 

Intervention and Outcome: I adjusted his C5 P-A and atlas PIL using an adjusting instrument. He said he was feeling only somewhat better after his 15-minute rest, but called the next morning to report that the paralysis was mostly gone. It was completely gone after three days and has not returned in the last two years.

 

Case #5

 

History: This 88-year-old female suffered frequent episodes of vertigo, tinnitus and nausea for 45 years. She was in a moderate car accident a few years before onset, in which she was a passenger and was not wearing a seat belt. During episodes, she walked around her home holding onto the walls, trying to keep her head level at all times. She reported numerous falls over the years, some resulting in broken bones.

 

She was diagnosed with Meniere's disease at the University of Michigan Hospital in Ann Arbor and Memorial Hospital in Chicago. She tried a variety of medications to help sleep, but saw no reduction of symptoms. Surgical history of colostomy and right radical mastectomy was noted.

 

Examination: Subject reported severe dizziness; blindness in the left eye; fullness in the right ear; pain and stiffness of the neck; and numbness in the left thumb. She was unable to lift her left arm above her shoulder. She exhibited limited range of motion with left lateral flexion and left rotation of the head. Edema was noted below the posterior base of the occiput.

 

Leg checks showed a one-inch RPP and a one-inch left cervical syndrome. Modified Prill check elicited positive test for C1 subluxation. Cervical X-rays revealed narrowed disc spaces at multiple levels, particularly evident at C6 and C7. Minimal marginal spurring and bony overgrowth of facet margins were noted. The atlas was subluxated posterior and inferior on the left articulation, underlapped on the right. The fifth cervical was inferior and posterior.

 

Intervention and Outcome: Immediately following specific toggle-recoil adjustment of the atlas, the patient reported complete alleviation of vertigo and dizziness. When she awoke the following morning, the tinnitus also was gone. She held this adjustment and was symptom-free for two years.

 

After suffering a minor stroke, closely followed by three compression fractures caused by osteoporosis, the subluxation returned and a second adjustment was given. This adjustment has held for the past year.

 

Discussion

 

All of my Parkinson's, Meniere's, Trigeminal neuralgia and Bell's palsy patients have suffered trauma to the upper back, neck and/or head, and they all presented with posterior atlas subluxations with laterality on the opposite side.

 

subluxation

It is my theory that the pressure exerted by the subluxated atlas causes a combination of problems including, but not limited to, degenerative posture changes caused by carrying the skull too far anterior; decreased blood supply to the occipital portion of the brain; pressure on the nuclei of cranial nerves V (trigeminal) and VIII (vestibulocochlear); nerve-root irritation of cranial nerve VIII4; paralysis of the branches to the M. tensor veli palatini, which opens the Eustachian tubes;12 and/or compression preventing normal cerebrospinal fluid flow downward from the fourth ventricle into the spinal subarachnoid space, resulting in hydrocephalus.

 

Conclusion

 

Anyone who has had trauma to the upper body, neck and/or head, or been diagnosed with any disease related to a problem with the brainstem, should be evaluated by an upper-cervical-specific chiropractor.

 

References

 

1. The Merck Manual, 16th edition. Berkow RR. N.J.: Merck Research Laboratories, Merck & Co. Inc., 1999.

2. Elster EL. Parkinson's disease: upper cervical chiropractic management of Parkinson's disease patients, Today's Chiropractic, July-August 2000.

3. Pierce WV. Results, CHIRP, Inc., Dravosburg, Penn., 1981.

4. Burcon MT. Upper cervical protocol for ten Meniere's patients, Journal of Vertebral Subluxation Research; passed peer review and waiting publication.

5. Palmer BJ. The Subluxation Specific, The Adjustment Specific. Davenport, Iowa: Palmer School of Chiropractic, 1934.

6. Palmer BJ. Chiropractic Clinical Controlled Research. Volume XXV. Davenport, IA: The B.J. Palmer Chiropractic Clinic, 1951.

7. Palmer BJ. History in the Making. Volume XXXV. Davenport, IA: Palmer School of Chiropractic, 1957.

8. Sherman L. Neurocalometer-neurocalograph-neurotempometer research. Eight BJ Palmer Chiropractic Clinic Cases. Davenport, IA: Palmer School of Chiropractic' 1951.

9. Burcon MT. BJ's $50,000 timpograph, Chiropractic Economics, Nov/Dec 1995.

10. Prill CE. The Prill Chiropractic Spinal Analysis Technique, 2001.

11. Addington EA. Overview of Blair Cervical Technique, Council on Chiropractic Practice, Chandler, AZ, October 2-3, 1995.

12. Hamersma H. A New Look at Meniere's Syndrome. The Ear, Nose and Throat Institute of Johannesburg, Florida Park, Gauteng, South Africa.

 

Michael T. Burcon, DC

Grand Rapids, Michigan

www.burconchiropractic.com

[layton]

another one:

 

Choosing Treatments for Trigeminal Neuralgia

 

R.A. Lawhern, Ph.D.

 

This article is for people who have been informed by a medical or dental professional that they have a condition called "trigeminal neuralgia." We are concerned here with the question, "What treatments are available and how do I choose between them?" We will discuss options and (hopefully) shed some light on how you may choose between the options in a way that works best for you. As we begin, please accept this reassurance: although trigeminal neuralgia (TN) can be a long-term life issue for many people, a high percentage of patients find effective management and even long-term resolution of their TN through medications or surgical procedures.

 

About the author:

 

The author of this article has been webmaster for the TNA Homepage and was a member of the Board of Directors of the Trigeminal Neuralgia Association for three years. My spouse has had TN with atypical features since 1996. For three years I have assisted patients with information research on causes and treatments of Trigeminal Neuralgia and other facial pain syndromes. However, I am technically trained in engineering -- I am not a medical doctor.

 

The Trigeminal Neuralgia Association has consented to publication of this article on its web site as a TN spouse contribution. The Association is not responsible for the medical accuracy of what appears here. You should assume that any errors are solely the author's. Before you accept or act upon the content of this article, you should give your physician a copy and discuss whether it applies to you. This work is offered for information only -- it is not intended to be substituted for the advice and counsel of a medical or dental professional. Likewise, the Association invites additional or contrary input by patients or professionals, concerning treatment choices for facial neuralgias.

 

What are the options?

 

There are no permanent "cures" that work for all patients who have pain from trigeminal neuralgia or similar conditions. However, many patients are able to be rid of their pain such that it never returns. Four general categories of treatments provide long-term pain relief or reduction for many patients, probably the majority. These categories are listed below in about the order in which most doctors consider them and recommend them:

 

*

 

Medical Treatment (e.g. anti-convulsive drugs that slow the function of nerves which cause your pain)

*

 

Medical Pain Management (drugs which moderate pain or treat related problems such as depression)

*

 

Surgical Treatment (of several types)

*

 

Treatments of Alternative Medicine

 

One important thing to remember is that treatment categories are not mutually exclusive. Many patients obtain acceptable management from drugs -- up to and including complete remission of pain. Some patients who have one of the surgeries for TN, will continue to take medications (though perhaps at reduced doses) if their relief has not been total or to control side effects of surgery. Patients in both categories seek out alternative treatments either to promote and assist the primary treatment they are receiving, or as a substitute treatment if other options don't work. Some physicians also recommend these treatments, for the same reasons.

 

Factors Which Affect Your Choices

 

The following factors can affect which of your treatment choices will work best for you -- and in some cases may eliminate some of your options. Let's talk briefly about each.

 

*

 

What is the type and distribution of your pain?

The way your pain emerges may affect the way it is initially diagnosed and treated. Effects of Trigeminal Neuralgia are generally felt in one of two ways. Typical or classic TN involves discrete incidents of intense, electric-shock type pain in one side of the face, which sometimes come in repeated "volleys" lasting an hour or more. Atypical TN may have a more "aching, burning" quality at a somewhat lower but still severe intensity, that seems to be continuous for long periods (days, weeks, longer). Sometimes people have pain on both sides of the face at different times, or a mixture of typical and atypical pain. However, any pain that affects the rear quadrant of your head or that crosses the mid-line of your face may involve other problems that are not trigeminal neuralgia. Some of the other medical conditions that can be mistaken for TN are indicated below.

 

As a general principle, the more closely your pain resembles "typical" TN, the more likely it is that anti-convulsive drugs like Tegretol or surgeries like Radiofrequency Rhizotomy or Microvascular Decompression will be successful in eliminating or reducing the pain. Many cases of "atypical" TN can be treated by these means -- but the more atypical the pain is, the greater the difficulty in obtaining reliable and long-lasting relief. Many surgeons are hesitant to operate on patients whose symptoms are highly atypical, because success rates in such surgeries are believed to be lower.

 

*

 

How did the pain start?

A lot of patients report that their TN pain seems to emerge "spontaneously out of nowhere." Sometimes patients have a first brief incident of pain and it then goes away for a long time before returning. Pain may recur several times, with gradually decreasing pain-free periods, before it comes to stay.

 

In other cases, patients say that the beginning of their pain coincided with a distinct event. Some report having an automobile accident, a fall, or a sharp blow to the face which involves injury (also called "blunt trauma"). A large proportion of patients report pain that preceeds undergoing a root canal or other dental surgery, and persists thereafter. While most neurosurgeons and dentists do not believe that dental surgery causes TN, they believe that dental work might initiate the first symptoms of the condition if it is already developing at the time dental work is done [Ref: Steven B. Graff-Radford, D.D.S., TN-Alert, Fall 1995].

 

We also know that a lot of people first experience TN pain at a small area along either their upper or lower jaw. Patients may at first mistake their pain for a dental abscess. They go to a dentist or endodontist who performs a root canal. This is one reason why it is very important that dentists should be trained to suspect that neurology could be involved if a patient has sharp, localized pain but no evidence of an abscess on Xrays. Unfortunately, it is still common for TN patients to receive root canals -- sometimes even multiple serious dental surgeries, each procedure unsuccessful and painful -- before anyone pauses to ask whether the problem may not be dental in origin.

 

A discussion of the origins of your pain is probably not complete unless we also mention a source that many doctors and dentists consider controversial: NICO (Neuralgia Inducing Cavitational Osteonecrosis). The first mention of bone lesions of this type was made by Dr. G.V. Black in 1915, under the designation "osteomyelitis". A form of the disorder called "Ratner's bone cavities" was first discussed in 1979 by Dr. E.J. Ratner, and renamed NICO by Dr. J. Bouquot.

 

Ratner and some of his associates believe it is possible for an infection to become established in tiny pores or cavities of bone through which parts of the distribution of the trigeminal nerve pass. According to this theory, infection may take years to develop after an injury or surgery introduces bacteria into the bone. The nerve becomes inflamed due to the infection. Advocates of this medical model propose that pain may be treated by surgically opening these cavities, scraping out the infection and treating with antibiotics.

 

However, other dentists and many endodontists do not accept the idea of NICO, asserting that the bone cavities do not appear in dental X-rays or MRI imagery. They also argue against the idea that root canal can introduce infection in the first place, or that it may take years to develop to a level which causes widespread inflammation. At present, medical/dental practice has not arrived at a consensus concerning the proposals of Ratner, and the controversy continues in the medical community. For a more detailed discussion, the reader is referred to "NICO and Cavitations?", edited from an original article by Dr. Karen Evans.

 

The important thing to take away with from this discussion is that if your pain appears to emerge as part of a dental problem, then it may be appropriate to seek an orofacial consultation from a dental specialist who is also trained to recognize neurology problems. There aren't very many such people in practice, and you may need to find a facial pain center or teaching hospital to get help from an appropriate treatment team. Likewise, if "electric shock" face pain emerges shortly after an injury, then your treatment team may need to include a specialist in temporomandibular joint disorder, a trauma specialist, an orthopedist, or a chiropractor who works with the cervical spine. Your treatment options should definitely include a careful examination of all of your symptoms to determine if more than one disorder could be involved in your pain.

 

*

 

How do you react to medications?

Medication with anti-convulsant drugs is the first treatment that many doctors and neurologists recommend. In fact, one of the most reliable indicators that you actually have TN, is a rapid, positive response to an anti-convulsant drug like Tegretol (Carbamazepine). Many people are able to get total or near-total relief from the pain of TN by such means. However, patients respond to these drugs in highly individual ways. The required dose for pain relief may vary in a range that can reach over 1200 milligrams per day for Tegretol, and higher for other types of drugs. Before you reach a dose level sufficient to moderate your TN episodes, you might experience disturbing side effects: drowsiness, inattention, memory problems, blurred vision and balance problems are among the most common. As your body gets used to the drug, some of the effects may pass or decrease. However, some people seem to be outright allergic and cannot tolerate their reactions to such drugs. A few others -- particularly people with a history of bone marrow suppression, kidney or liver toxicity -- may experience toxic reactions that are quite dangerous. Such severe reactions can be avoided by periodic monitoring of your blood chemistry while you use these drugs.

 

Thus you should be mentally prepared to go through a period of experimentation and dose determination, if you choose medication as your treatment for TN pain. The process is somewhat similar to what is used in allergy medicine. You and your physician need to find a drug or combination of drugs that addresses your problem without producing side effects that you cannot tolerate. A number of different drugs can be used individually or in combination. If you cannot find a combination which works for you, your doctor may recommend that you be evaluated for some type of neurosurgery.

 

*

 

Are you depressed?

It's no secret that any chronic pain can be very depressing, both to the patient and to immediate family members. What may not be as widely known is that there are close biochemical links between pain and depression. Not only does pain suppress some chemicals in the brain that are needed to fight depression, but depression seems to affect chemical balances that make patients more sensitive to pain.

 

As a consequence, it is important for your examining doctor to be made aware of any changes that have occurred in your moods, your ability to enjoy favorite activities, or your sleep patterns since your TN has developed. Simple questionnaires can be administered to determine whether you are "down" in the same way that anyone may feel, who deals with continuous pain and limitation -- or whether something additional is going on that needs to be treated specifically. By treating you with antidepressant drugs, a neurologist and psychiatrist working together may be able to substantially decrease your sensitivity to pain and increase the overall quality of your life, thus making other treatments more likely to successfully control your TN.

 

*

 

What other medical conditions do you have?

It is important to evaluate your alternatives in the context of both your general health and other specific conditions that may complicate your treatment. As an example, if you already have hepatitis or a kidney problem, your doctors are less likely to treat you with the most commonly used drug, Carbamazepine. This drug is known to have a risk of toxic side effects in people who are vulnerable to liver or kidney problems. Similarly, if you have a heart condition which requires you to wear a pacemaker, you may be unable to undergo MRI (magnetic resonance imaging) procedures that doctors frequently use to check for signs of TN, Multiple Sclerosis, or slow-growing brain tumors (MRI machines can disturb the action of some kinds of pacemakers). This situation may require your doctor to use other methods such as CT scan, rather than MRI.

 

Although research statistics are presently incomplete, it is known that multiple sclerosis (MS) and trigeminal neuralgia can occur together in some patients. Perhaps five percent of TN patients also have MS. The "plaques" or small scars which MS causes in the myelin covering of nerves may be a cause of symptoms like those of TN, even when the most common cause of TN (physical compression of the nerve by blood vessels) is not present.

 

As indicated in an article by Ronald Brisman, M.D., of the Neurological Institute at New York Presbyterian Hospital, "Medical management through the use of anticonvulsants is initially pursued for those with TN and MS. While this may be effective for many with this dual problem, many patients find that the use of these medications aggravates their MS symptoms such as balance and strength. If the medications cannot be tolerated or are ineffective, [then] neurosurgical procedures, especially the minimally invasive percutaneous procedures - glycerol injection, radiofrequency and balloon compression - may be helpful. Since compression of a blood vessel is not usually the cause of TN in an MS patient, microvascular decompression is generally not pursued as a choice of medical intervention. [Note] Recurrence rates following these procedures are slightly higher in those with MS, but in most cases, can be repeated as needed."

 

Author's Note [R.A.L.]: Gamma Knife radiosurgery is the most recent technique that has been pursued for some MS/TN patients. Although some patients have been helped by Gamma Knife, the results of this procedure appear to be better for TN patients who do not have MS.

 

It is also important for trigeminal neuralgia patients to understand that more than one disorder can be involved in their symptoms -- and the more "atypical" their symptoms are of classic TN, the more this may be true. Especially if you have pain in other areas of your body or head at the same time, your physician should consider other disorders, either "instead of" or "in addition to" TN, that may require different treatments. Such disorders may include the following:

o

 

glosso-pharyngeal neuralgia (involving a different cranial nerve than does TN)

o

 

greater or lesser occipital neuralgia (again, affecting yet another nerve)

o

 

facial tendonitis of several types (inflammation of a small tendon)

o

 

temporo-mandibular joint disorder (misalignment or damaged structure in the joint and its closely surrounding tissues)

o

 

abscessed tooth

o

 

a slow growing tumor close to the trigeminal nerve

o

 

acoustic neuroma (a tumor of the auditory nerve)

o

 

growths on or misalignment of the upper (cervical) spine, with referred pain in the face.

 

 

For further discussion of several of these syndromes, the reader may find Pain Disorders That Are Confused With TMJ to be a useful starting point. These and other syndromes are also addressed by several of the Organizations linked from the Trigeminal Neuralgia Association homepage.

 

Some conditions such as anesthesia dolorosa or some forms of hearing loss can result from previous treatments of TN itself, particularly if you have had surgeries. Some procedures reduce pain by damaging the trigeminal nerve in selective ways. Over time, the body may compensate for the damage by regenerating the nerve, causing a return of the pain. It is understandable that even controlled damage can become cumulative. Patients who have already had multiple surgeries have a noticeably lower probability of success in repeated procedures. For such patients, on-going treatment by a pain management specialist may be helpful.

 

*

 

What is your age and physical condition?

Historically, some doctors have discouraged older patients from having microvascular decompression surgery, out of a concern that risks of serious side effects may be higher for such patients than for younger people. However, opinion on this area of practice seems to be changing. A 75 year old patient who power-walks a mile, three days per week and who has low cholesterol, may be a better candidate for inter-cranial surgery than, say, a patient of 50 who has very high blood pressure and shows signs of developing angina or respiratory problems.

 

Likewise, the prospect of taking anti-convulsive drugs for the rest of one's life may seem highly unattractive to a physically active 30 year old who is concerned about potential side effects on memory, mental clarity and physical balance. Some younger patients may press for early surgical treatment which has a probability of a long-term, drug-free outcome -- even knowing that there is some possibility of an unsuccessful result or lasting negative side effects. Some physicians are coming to see this preference as a reasonable one, if the patient is fully informed of the possible negative outcomes of surgery.

 

*

 

How long you have had pain?

Yet another factor in selecting treatments seems to be in the very early stages of research. Some reports of surgical outcomes indicate that after pain has lasted for a few years, the probability of success for surgery seems to be somewhat lower than if surgery is done more immediately after pain begins. One possible explanation for such effects would be that the compression that creates TN pain may also gradually create abnormal circuits in parts of the nerve that are remote from the site of the compression. By this explanation, if the original compression is removed, the abnormal circuitry may continue to cause pain. While this observation has not yet been conclusively verified, it may prompt greater willingness by surgeons to provide treatment after relatively shorter periods of drug treatment, if the patient is not receiving adequate pain relief from drugs.

 

If you are an older person who no longer drives a car or whose driving may be restricted by your pain, it may not be easy for you to travel 400 miles to speak with a doctor who has special training in the treatment of facial neuralgias. The same can also be true for younger people, of course. Such practical limitations can affect the choices in treatment that you feel able to explore. Especially for patients whose ability to travel is restricted, it is vital that you or a member of your family do as much as you can to learn about your options -- and the care providers who deliver such options -- as early as you can. This page may be part of your learning process. See the page menu above, for other materials of the TN Association that may also be helpful.

 

Beyond this initial research, it will be important for you to find an appropriately qualified doctor as close to you as possible. The Trigeminal Neuralgia Association and its affiliated support groups and network contacts can assist you in the search.

 

*

 

What is your relationship with your doctor?

If you have a strong and trusting relationship to a medical care giver who has correctly diagnosed your TN pain, then you may wish to continue that relationship as you seek treatment -- even if your doctor or dentist refers you to other practitioners who have specialized training and information. Your primary doctor can "sanity check" and help you evaluate the suggestions you receive from others. It is also important to realize that you are more likely to have successful outcomes if you are seen by professionals who routinely treat other patients with similar disorders. Just as you would not take a case of skin cancer to a chiropractor, neither is it wise to seek TN treatment solely from a family practitioner who lacks recent training in neurology. Likewise, if you choose one of the surgical treatment options, your outcomes will likely be better with a neurosurgeon who specializes in treating TN and does many similar procedures per year, than with a general neurosurgeon who treats all manner of neurologic problems and does only a few procedures of the type recommended for your case.

 

*

 

How complex is your case?

If your TN pain has just emerged and you have had successful relief of pain by taking an anticonvulsant drug under supervision by an Internist, it may be that this practitioner will be quite adequate to supervise medical management of your disorder. However, if you are having difficulty with your medical treatment, or new problems are emerging after a long period of previous success, then you may need to reevaluate whether you need to find more specialized assistance from another doctor. So how do you decide who is best qualified?

 

There are several questions you can ask a physician, to assess whether he or she is someone you wish to work with in TN treatment or management. Surveys reported over the past 30 years in the medical and popular press suggest that patients who are passive and uncritically accepting of their doctors' advice tend to do less well on outcomes. [see, for instance, BA Schulman or WM Strull, et al] Actively questioning the reasons behind the doctor's advice may improve your chances of a good result by drawing the physician's attention to factors in your case that may not have been noted or accorded proper significance.

 

The answers you receive to questions like those below can be indicators to help you evaluate your relationship to a doctor and the advice he or she gives you. No care giver is going to score perfectly on every point in the list. However, the more positive answers you receive, the more confidence you can have that you are placing yourself in good hands. All of these points are worth discussing when you interview a doctor you don't know.

 

o

 

"How much do you expect me to become involved as a member of my own treatment team and how will you assist me to do so? If I cannot be active in this way, would you be willing to invite someone in my family to act on my behalf?"

 

o

 

"What are the risks and benefits of the procedures you advise? What is the success rate among people you treat? What other procedures are there? Can I talk to somebody about procedures you do not usually employ? "

 

o

 

"How many of these surgeries have you done? How often is the procedure completely effective? Partially effective? What percentage of your patients died during or shortly after surgery? If you have only done the procedure a few times, then will you be assisted in the operating theater or clinic by a more experienced surgeon? If the surgery isn't successful, then what do we do next?"

While there is probably no generally accepted standard of practice for numbers of procedures a doctor does, it may be reassuring to know that the surgeon does a procedure 50 times per year, rather than only five times.

 

o

 

"Do you maintain active relationships to other physicians in related fields, and can you make a referral for a second opinion on what you propose?"

 

o

 

"Have you had recent continuing medical education in a pertinent field? Have you taught other doctors?

 

 

o

 

"Like other professionals, doctors sometimes find that about half of what they were taught in medical school is outdated within five years. Keeping up with research is always difficult. However, do you or somebody on your office staff subscribe to a medical clipping service, to keep current on research in your specialty?"

 

o

 

"How can I become current on what is going on in medicine that applies to my case? Does your office provide written information and/or Internet sites I can read at home, to understand the treatments proposed for me?"

 

o

 

"Do you treat other complicated cases and regularly see other patients who have problems similar to mine? Would any of your patients be willing to discuss their surgery with me?"

 

Summary of Treatment Options

 

The following list summarizes treatment options you may choose from or combine, to find resolution or relief for your TN. These options are often combined, and not all of them apply for all stages of treatment in all patients. Consult your healthcare provider for advice on which modes of treatment are most appropriate for you. More information is available on each of these options from off-site Organizations and Resources and from on-site articles referenced in this article.

 

*

 

Medical Treatment

o

 

Anti-Convulsive Drugs (Tegretol, Neurontin, Dilantin, others)

o

 

Anti-Spasticity Drugs (Baclofen)

o

 

Tri-Cyclic Anti-Depressant Drugs (amitriptyline, protriptyline, nortriptyline, others).

*

 

Medical Pain Management

o

 

NSAIDS (Aspirin, other non stereoid anti-inflammatory drugs)

o

 

Opioids (Percodan, Oxycodone, MS Contin, others)

*

 

Surgical Treatment

o

 

Nerve Block

o

 

Glycerol Rhizotomy

o

 

Balloon Rhizotomy

o

 

Radio Frequency Rhizotomy

o

 

Microvascular Decompression

o

 

Stereotactic Radiosurgery

o

 

Partial Nerve Section

o

 

Neurectomy

*

 

Treatments of Alternative Medicine [Author's Note 2]

o

 

Acupuncture

o

 

Acupressure

o

 

Ayurvedic Medicine

o

 

Biofeedback

o

 

Capsaisin Cream

o

 

Chiropractic

o

 

Exercise

o

 

Meditation and Creative Visualization

o

 

Self Hypnosis

o

 

Transcutaneous Electro-Neural Stimulation (TENS)

o

 

Vitamin Supplements

 

Note 2: Patients and their families should be aware that medical evidence for the efficacy of "alternative medicine" treatments is not yet established consistently in clinical studies. There are anecdotal reports of positive benefits in some patients, but responses appear to be highly individual. Some patients also report a worsening of their pain while undergoing such treatments. These techniques should not be viewed as a substitute for regular consultation and medical management by a qualified physician or craniofacial pain specialist.

 

The choices and combinations between these treatment options are influenced by the factors discussed in this article. Please talk about your choices with your primary medical care provider or other specialists in neuralgia pain, before committing yourself to a course of action. Above all, please study so that you can become a more informed health services consumer.

 

Updated 4-19-02

[layton]

last one, there is a lot of information on the web too

 

From Web MD:

 

Pain Management: Facial Pain

 

* What is trigeminal neuralgia?

* What causes trigeminal neuralgia?

* What are the symptoms of trigeminal neuralgia?

* How is trigeminal neuralgia diagnosed?

* How is trigeminal neuralgia treated?

 

Pain originating in the face, or elsewhere, may be caused by an injury, an infection in a structure of the face, a nerve disorder or it may occur for no known reason.

 

Some common causes of facial pain include:

 

* Abscessed tooth (a condition in which a tooth is surrounded by inflammation and pus)

* Sinus infection

* Sinusitis (inflammation of the sinuses)

* Injury to the face

* TMJ disorders (TMJ stands for temporomandibular joint, or the jaw joint)

* Trigeminal neuralgia (described below)

 

What Is Trigeminal Neuralgia?

 

Trigeminal neuralgia (TN), also called tic douloureux, is a condition that is characterized by intermittent, shooting pain in the face.

 

Trigeminal neuralgia affects the trigeminal nerve, one of the largest nerves in the head. The trigeminal nerve sends impulses of touch, pain, pressure, and temperature to the brain from the face, jaw, gums, forehead, and around the eyes.

 

What Causes Trigeminal Neuralgia?

 

The most frequent cause of trigeminal neuralgia is a blood vessel pressing on the nerve near the brain stem. Over time, changes in the blood vessels of the brain can result in a blood vessels rubbing against the trigeminal nerve root. The constant rubbing with each heartbeat wears away the insulating membrane of the nerve, resulting in nerve irritation.

 

What Are the Symptoms of Trigeminal Neuralgia?

 

Trigeminal neuralgia causes a sudden, severe, electric shock-like, or stabbing pain that lasts several seconds. The pain can be felt on the face and around the lips, eyes, nose, scalp, and forehead. Symptoms can be brought on when a person is brushing the teeth, putting on makeup, touching the face, swallowing, or even feeling a slight breeze.

 

Trigeminal neuralgia is often considered one of the most painful conditions seen in medicine. Usually, the pain is felt on one side of the jaw or cheek, but some people experience pain at different times on both sides. The attacks of pain may be repeated one after the other. They may come and go throughout the day and last for days, weeks, or months at a time. At times, the attacks can disappear for months or years. The disorder is more common in women than in men and rarely affects anyone younger than 50.

 

How Is Trigeminal Neuralgia Diagnosed?

 

Magnetic Resonance Imaging (MRI) can be used to determine whether a tumor or multiple sclerosis is irritating the trigeminal nerve. Otherwise, no test can determine with certainty the presence of trigeminal neuralgia. Tests can, however, help rule out other causes of facial disorders. Trigeminal neuralgia usually is diagnosed based on the patients description of the symptoms.

 

How Is Trigeminal Neuralgia Treated?

 

Trigeminal neuralgia can be treated with antiseizure medications such as Tegretol or Neurontin. The medications Klonapin and Depakote may also be effective and may be used in combination with other drugs to achieve pain relief. Some antidepressant drugs also have significant pain relieving effects.

 

If medications are ineffective or if they produce undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity.

 

Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation.

 

Reviewed by the doctors at The Cleveland Clinic Neuroscience Center.

Edited by Charlotte E. Grayson, MD, WebMD, June 2004.

 

 

[archenemy]

I recommended chiropractic adjustments, but obviously only if there are no contraindication to it. Seems like there are. With trigeminal neuralgia, your options are fairly limited to drugs and or surgery. As far as I know, most people would be willing to try anything to avoid at least the surgery part. No chiropractor should claim that it will help, but it is worth a try if the rest of your history and imaging is clean...call it experimental conservative treatment. Massage, PT, or acupuncture could be other alternatives. I'd still give it a shot if there isn't evidence of instability, infection, tumor, basilar impression...basically anything a high velocity, low amplitude impulse would fracture, dislocate, or jar something loose into your system. I assumed you were clear since you are also a climber and there's a whole lot more dangerous neck movement involved with that (and looking back to change lanes!).

 

I hope you find something that helps and the cure isn't worse than the disease.

Again, there are things that should not be tried just because they are available or because drug therapy or surgery doesn't seem like it is the best option in some folks' opinions.

 

I appreciate your passion in your new field, it is obvious that you have people's well-being in mind. But to always suggest chiro adjustments might cause someone to think, "Well, when all you have is a hammer, every problem is a nail". I'd hate to see that because adjustments really are a great thing for certain issues.

[layton]

Perhaps you didn't read the information I supplied. As for the hammer analogy...you obviously haven't read much of what I've written very carefully.