Trigeminal neuralgia, a disorder of the trigeminal nerve, is a condition that produces intense, sporadic facial pain along one or more of the three branches of this nerve. The pain is severe and can last from seconds to minutes. Another name for this condition is “tic douloreaux” due to the fact that facial muscle spasms often accompany the pain. The pain can be triggered by normal activities such as eating, brushing of the teeth or even touching trigger points on the face during everyday activities such as washing the face or applying make-up. Wind, cold, heat, stress or fatigue may aggravate the condition. The pain is typically one sided, more common in women and more common in the over 40 population. The condition may become chronic and debilitating, often lasting for years.
Once Western medicine utilizes an MRI exam to rule out a physical obstruction pressing on the trigeminal nerve or multiple sclerosis, which can mimic the same symptoms, the choice of treatment is drug therapy to control the pain. Often drugs such as Tegritol or Neurontin can control the pain, but not without the significant risk of side effects ranging from dizziness and nausea to serious heart, liver, kidney and blood complications. Occasionally, surgical intervention is the last resort to provide relief.
If the first branch of the trigeminal nerve is compromised, the nose and eye area will be affected. The second branch is related to the nose and upper jaw. The third branch supports the lower jaw and ear.
The basic premise behind the theory of acupuncture is that energy flows thru the body on very specific pathways called meridians. When these pathways become blocked, pain and disease result. Inserting very fine needles into points on the pathways facilitates the smooth flow of energy and pain is relieved. There are many acupuncture points on the face that directly correlate to the three branches of the trigeminal nerve. One common approach to treat trigeminal neuralgia with acupuncture is to insert very fine needles into the corresponding facial points in an attempt to unblock the energy. Sometimes the needles are additionally stimulated with electricity to strengthen the treatment.
Other schools of thought, and MY first approach, use distal points (points on the arms and legs) that will directly affect the meridians on the face. I rarely put a needle into the part of the body that has pain. Often within minutes of inserting a needle on the leg opposite to the facial pain, the patient will feel relief. This is because there is a very complex network of energy pathways that connect the meridians and a very sophisticated set of relationships between the various pathways. After a series of acupuncture treatments, episodes of facial pain often become much less frequent or subside altogether.
Traditional Chinese medicine will diagnose the underlying cause of the energy blockage by inquiring about all bodily functions, examining the tongue and taking the pulses on both wrists. Additional needles are placed to address the underlying cause of the pain. The goal is to address both the pain AND the underlying cause which varies from person to person.
For example, if the nature of the pain is burning, aggravated by heat and alleviated by coolness, Chinese medicine believes that heat may have actually lodged in the energy pathways. If the person sweats and appears to have a red complexion during the episode and presents with a red tongue and rapid pulse, the diagnosis of heat invasion will become even more evident. Specific points on the affected meridians have the function to clear heat and would be added. Patients with this presentation would be advised to avoid spicy foods and alcohol, which create heat in the body.
If the episodes are aggravated by stress and spasms are predominant, there are other points that traditionally have been known to relax the body and calm the mind. My patients often tell me that they are better able to cope with the stress in their lives after acupuncture treatments. Patients in this category often have a slightly purple cast to the tongue and a pulse that feels like a guitar string.
Other underlying causes may be related to the normal aging process and a different tongue picture and pulse will become part of the overall diagnosis. In this case, herbs may be suggested to tonify the body while addressing the facial pain.
In any case, acupuncture has been shown to be effective in treating trigeminal neuralgia. And without side effects!