Trigeminal Neuralgia Treatment
What is Trigeminal Neuralgia?
Trigeminal Neuralgia is a pain condition that involves the three branches of the trigeminal Nerve. The trigeminal nerve primarily carries sensory information between the face and scalp, and brain. Sufferers often describe a shock-like, stabbing or shooting pain on one side of their face. This pain can last anywhere between half a second and a few minutes. These attacks can happen once per day or up to 50 times per day. Sometimes, sufferers may describe tearing or redness in their eyes, on the same side as their pain [1].
Trigeminal Neuralgia sufferers are often hypersensitive to things such as; brushing teeth, chewing, light touch around the face or even speaking. These types of activities can often lead to an attack for these people. Women are more likely to experience Trigeminal Neuralgia than men, and it is most likely to happen in people aged 50 years or older.
Anatomy of the Trigeminal Nerve
There are 3 branches of the Trigeminal Nerve. The Opthalmic Branch (V1) innervates the area around your eyes, nose and from the top of your forehead, into your scalp. The Maxillary branch (V2), innervates the area from your temple, down to your cheeks and upper lip. The mandibular branch (V3), innervates the remainder of your temple and jaw, but is also associated with the muscles involved with chewing [2, 1].
Types of Trigeminal Neuralgia
1. Classical Trigeminal Neuralgia
This is when the only cause of Trigeminal neuralgia is due to neurovascular compression. This often happens due to damage of a nerve, around the nerves root from the brainstem, because of compression by an artery or vein. Further; ‘Primary Paroxysmal’ Classical Trigeminal Neuralgia, indicates that the sufferer has pain free periods. Whereas, Concomitant Continuous pain, suggests that the sufferer experiences mild pain between attacks [1].
2. Secondary Trigeminal Neuralgia
When an underlying disease causes Trigeminal Neuralgia, it is classified as Secondary Trigeminal Neuralgia. This might be from, Multiple Sclerosis, tumour or arteriovenous malformation [1].
3. Idiopathic Trigeminal Neuralgia
Idiopathic Trigeminal Neuralgia is when a sufferer experiences the symptoms of Trigeminal Neuralgia, but there is no apparent cause found on investigation. This can suggest pathology or sensitivity of the brainstem may be involved [1].
As with Classical Trigeminal Neuralgia, it can be classified as ‘Purely paroxysmal’ or “Concomitant Continuous Pain”. Approximately half of all Trigeminal Neuralgia Patients experience continuous pain.
Trigeminal Neuralgia is commonly not diagnosed, or misdiagnosed, for long periods of time due to the similarity in its symptoms from those of migraine and cluster headaches.
What is the cause of Trigeminal Neuralgia?
As mentioned above, there are quite a few different causes of Trigeminal Neuralgia, especially with Secondary Trigeminal Neuralgia. What we see commonly in our patients who suffer from Trigeminal Neuralgia, is a sensitised brainstem and dysfunction in the cervical spine where it is located [1][2].
This sensitised brainstem perceives otherwise non-threating stimulus (such as chewing or brushing your teeth) and reacts as if it were a threat. The brainstems reaction to this threat is to cause pain along the area that the Trigeminal Nerves innervate. This is how sufferers of Trigeminal Neuralgia can experience attacks so frequently, with seemingly innocuous triggers.
I’ve tried it all, What else can be done to help Trigeminal Neuralgia?
Many of our patients who suffer from Trigeminal Neuralgia have tried many different therapies, including; strong pain-killers, anti-convulsant medication, Botox Injections or even surgery. These may have had some short-term or mild benefit, but the pain always returned. This is where the Headache and Migraine Clinic can help, we are trained to specifically assess your cervical spine and the sensitivity of your brainstem, to see if they are the true cause of your Trigeminal Neuralgia. If that’s the case, then we can start treatment immediately, to cure the cause of your pain and not just cover up the symptoms.
Treatment will be addressing the dysfunction in your cervical spine, and then will aim to de-sensitise your brainstem with our world-leading manual techniques. Once treatment has started, we expect to see rapid results within the first 6 sessions, as we do with 85-90% of our patients. The best bit is that it is gentle, safe, non-invasive and medication-free.
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What are Cluster Headaches?
Cluster Headaches are a rare type of headaches that affect around 0.1% of the population, according to the International Headache Society. While they are rare, it does affect males 3-4 times more frequently than females [1].
Despite being uncommon, Cluster Headaches are regarded as being the most severe and debilitating type of headache. Research has shown Cluster Headaches frequently described as having the highest pain levels [2], out of all 300 different types of headache and migraine. Cluster Headache attacks occur in cycles, and will often wake sufferers during the night, or at regular times during the day. Attacks generally last between 15-180 minutes, and can happen multiple times per day, or once every couple of days [1, 2]. People who suffer from Cluster Headaches generally experience periods of attacks, or “cluster periods” that can last weeks or months. These periods are then followed by periods of remission lasting weeks, months or even years. The pain is often severe, on one-side of the head, and generally around the eye and/or temple region. Cluster Headaches have adopted the nickname, ‘suicide headaches’ due to their severe and debilitating nature [2].
What are the signs and symptoms?
Cluster Headaches are often severe enough that a sufferer cannot keep still during an attack. They may pace back and forth, have to take a shower, or even resort to banging their head in an attempt to reduce the pan.
Symptoms commonly associated with Cluster Headaches include [2]:
- Severe pain around one eye, that can radiate further around the face or neck
- Restlessness, shortness of breath and/or a sweaty face
- Watery/teary eyes or eye redness
- Swollen or droopy eyelids
- Runny or congested nose
- Pale or flushed skin
- Pain is unilateral, or affects only one side
What are the different types of Cluster Headache?
There are 2 types of cluster headache.
Episodic Cluster Headache
Cluster Headaches most commonly occur episodically. This is when sufferers experience bouts of “cluster periods” that can last for weeks or months, followed by an extended period in remission that can last up to years. They can occur seasonally or at set times each year. Episodic Cluster Headaches account for up to 80% of all Cluster Headaches [1, 2].
Chronic Cluster Headache
When Cluster Headaches occur without a prolonged period of remission, they are termed a Chronic Cluster headache. Sufferers often have “cluster periods” that will last over a year. While they may have days without attacks, the remissions will not last longer than a month.
What are the risk factors?
- Men are 5-6 times more likely to experience cluster headaches
- Sufferers are generally heavy smokers
- Higher alcohol consumption may be a factor
- Cluster Headaches most commonly affect people aged 20-50, but can occur at any age
- People with family members who are sufferers may be at a higher risk
What causes Cluster Headaches?
Historically, it was believed that cluster headaches, as well as migraines, were caused by the dilation of blood vessels in the head, causing pain. This was thought because medications, like triptans, are effective at relieving the pain if taking early enough in an attack. It was believed that triptans prevent this vessel dilation. However, recent research has shown that Cluster Headache and migraine sufferers do not experience blood vessel dilation at any different levels to people who do not suffer. So, how do these medications work?
Modern research has shown that Cluster Headaches and migraines arise from increased sensitivity in the central nervous system [2], more specifically, a sensitised brainstem which is located in the upper cervical spine (the upper neck). Faults in the upper neck can lead to this sensitised brainstem, which then can refer severe pain and associated symptoms into the head and face [3]. Triptan medication has also more recently been shown to de-sensitise the brainstem [4], as well as its original purpose of constricting blood vessels in the head. This would explain why they work, as well as identifying a sensitised brainstem and the cervical spine as a cause of cluster headaches.
I've tried it all, is there anything that can help me?
While Cluster Headaches are very uncommon, they are still experienced in the Gold Coast region. The severity of symptoms causes sufferers to try a range of therapies in an attempt to resolve them, with mixed results. Often, they have tried; medications, injection therapy, or even surgical interventions such as, nerve blocks or blood vessel cauterisation.
At The Headache and Migraine Clinic, we aim to use the most modern research to find the root cause of your cluster headaches. If we can determine that a sensitised brainstem is the cause of your headaches, then we can use world-leading treatment techniques to address the faults in your neck and de-sensitise the brainstem. We have seen plenty of Cluster Headache sufferers at our clinics, and have an 85-90% success rate with our treatment technique. The best part is that it is safe, non-invasive and medication-free.
