Trigeminal neuralgia is inflammation of the trigeminal nerve, causing intense facial pain. It is also known as tic douloureax because the pain can cause patients to contort their face into a grimace and cause the head to move away from the pain. The obvious movement is known as a tic. The trigeminal nerve is a nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face such as brushing your teeth, or putting on makeup may trigger pain.
Occurrence: Trigeminal neuralgia affects women more often than men, and it’s more likely to occur in people who are older than 50.
Symptoms: The pain can come in sharp spasms that feel like electric shocks. It generally occurs on one side of the face and may be brought on by sound or touch.Causes: A swollen blood vessel or tumour that puts pressure on the nerve can cause it. Multiple sclerosis, a condition that damages the myelin sheath, which is the protective coating around nerves, leads to it. The pain represents an irritation of the nerve. The cause of the pain usually is due to contact between a healthy artery or vein and the trigeminal nerve at the base of the brain. This places pressure on the nerve as it enters the brain and causes the nerve to misfire.
Triggers: Touching the skin lightly, washing, shaving, brushing teeth, blowing the nose, drinking hot or cold beverages, encountering a light breeze, applying makeup, smiling, talking.
Trigeminal neuralgia is an extremely severe facial pain that tends to come and go unpredictably in sudden shock-like attacks. The pain is described as stabbing, shooting, excruciating or burning. It usually lasts for a few seconds but there can be many bursts of pain in quick succession. Trigeminal neuralgia is often caused by blood vessels applying pressure to the root of the trigeminal nerve.
Trigeminal nerve: It is one of 12 pairs of nerves that are attached to the brain. The nerve has three branches that conduct sensations from the upper, middle, and lower portions of the face, as well as the oral cavity, to the brain. More than one nerve branch can be affected by the disorder. Rarely, both sides of the face may be affected at different times in an individual, or even more rarely at the same time.
Area of pain: The area of pain will be based on the three branches of the trigeminal nerve—Ophthalmic (affects the forehead, nose, and eyes), Maxillary (affects the lower eyelid, side of nose, cheek, gum, lip, and upper teeth), and Mandibular (affects the jaw, lower teeth, gum, and lower lip).
Etiology and pathology
Exterior: Wind-Cold Invasion
Interior: Liver/Stomach Fire
Interior: Yin Deficiency
Wind-Cold Invasion
Treatment points: For pain in the supraorbital region, local: Taiyang, GB 14,UB 2; distal: TH 5, LI 4. For pain in the maxillary region, local:
ST 2, SI 18, LI 20; distal: LI 4. For pain in the mandibular region, local:
ST 6, ST 7; extra point 1 cun lateral to CV 24; distal: LI 4, Wind-Cold, Add GB 20. Liver/stomach fire, add Liv 3, possibly Liv 2, ST 44. Yin deficiency, add KD 6, SP 6.
The author is Head of the Department of Acupuncture, Sir Ganga Ram Hospital, Delhi.
This treatment is now being made available in India.