Trigeminal Neuralgia & The Neck
Many of you may have heard of the horrific experiences of trigeminal neuralgia, otherwise known as the suicide disease. This condition is believed to be less common, however those who have it normally report that the level of pain is unimaginable. Many have associated it with the worst pain a human can experience and nearly 25% of suffers will even commit suicide due to the unbearable debilitating pain. Let’s dive into why this illness is so painful, why the cause may be obscure, and potential treatment or palliative options like NUCCA foundational correction provided at Balance Chiropractic in Colorado Springs.
Trigeminal Nerve Anatomy
Trigeminal Neuralgia is a disease that attacks one of the twelve cranial nerves that originate from the brain or brain stem. The trigeminal nerve. This is also the largest and most complex of the cranial nerves and consist of three major branches that collectively are responsible for sensations of pain, temperature, and touch from the face, head, front of the tongue, and even the upper part of the neck. The third branch (mandibular) also transmits motor supply to the muscles of mastication in the jaw. Thanks to this nerve we can chew food! This nerve even supplies some structures in the ear and Eustachian tube. Information is carried from this nerve to a part of the brainstem called the pons which is then relayed to the cerebral cortex of the brain for interpretation. In the case of Trigeminal Neuralgia, something irritates the nerve which triggers something called a nociceptor. That receptor sends signals throughout the entire nerve pathway, into the spinal cord, and up into the brain where it is perceived as pain. Remember ever hitting your elbow in just the right spot against something? It’s always (shockingly) painful.
Peripheral or Central?
While the cause of this illness is still controversial, science has categorized it as either peripheral or central. In a peripheral lesion, something like a tumor or pulsations from a malformed blood vessel may compress the trigeminal nerve and cause a shocking like pain throughout the head, face, and jaw. The pulsations from the compressing vessel may explain why patients feel waves of electric pain followed by moments of relief in between.
In the central lesion, something called the trigeminocervical nucleus comes into play. This piece of anatomy is like Grand Central Station for information coming from the trigeminal nerve. Not only does it gather information from the three branches of the nerve, but also gathers input from an extension of the nerve called the spinal tract of the trigeminal nerve which travels down the neck to about the second or third cervical vertebral level. Neurological studies have demonstrated that the densest region of information overlap is at the C1-C2 level.
Diving deeper into the anatomy of the head and neck can reveal the complexity of the central type of lesion. Understanding the difference between the two is important because they warrant very different treatment options.
Common treatments for trigeminal neuralgia are often focused on the effects or symptoms from the illness yet many times fail to address the underlying cause. Anti-inflammatory medications are usually the first line of defense followed by anti-convulsion drugs. While these may be effective for decreasing the pain experienced by some, many patients find the side-effects that include dizziness, balance problems, and nausea to be intolerable.
In peripheral lesions, imaging is done by a specialist that confirms compression of the trigeminal nerve by a blood vessel or sometimes tumors. Surgeries including microvascular decompression (MVD), percutaneous balloon compression, and caudalis dorsal root entry zone (DREZ) can be done to physically take the pressure off the nerve. While some of these surgical interventions seem to have good initial success rates, complication may arise from a major surgery requiring incisions into the skull. Recurrence of symptoms after surgery seems common based on the particular procedure. Other options like radiofrequency ablation can be done where the nerve is actually burned with specific radiation to stop it from transmitting pain signals to the brain. As you can imagine, burning a nerve that has various vital functions for the face and jaw may leave behind some other issues…
These procedures may be a great option for a peripheral lesion, so long as the diagnosis is confirmed by imaging. Yet, a patient must always weigh the risks to benefits in a procedure that requires invasive intervention.
Central Processing Error
What happens if the patient is dealing with a central type of trigeminal neuralgia? In this case, it is the brain that is not perceiving input from the trigeminal nerve correctly. When there is a disruption in the normal firing through-out this pathway, the brain may interpret pain when in fact, there is not a painful stimulus. When this happens repetitively over the course of time it creates a phenomenon called central sensitization. A patient with central sensitization is much more sensitive to pain, sometimes even perceiving pain from simple touch and pressure. Central lesions are complex to understand and diagnosis because there is not simply a blood test or diagnostic image that can give definitive proof of the issue.
A variety of things can affect our perception of pain traveling along this neurological highway including environmental factors, genetics, chemicals, and mechanical stress. Pain experienced in the face, can be a result of a disruption anywhere along the pathway of the trigeminal nerve, including as mentioned above, the trigeminocervical nucleus. These factors can change the processing frequency from the trigeminal nerve to the brain which can explain why a simple breeze to the face or just brushing your teeth can cause excruciating pain in someone with trigeminal neuralgia.
The CCJ Interference
The cranio-cervical junction may be a likely culprit in the trigeminal neuralgia mystery. This junction is the skeletal connection between the bottom of the skull and the top bone in the spine. The perception of pain is dependent on sensory information to and from the brain through the spinal cord. By understanding some of the anatomy in the upper neck, we can understand how injuries to the neck may interfere with information processing of the trigeminal nerve. The atlas vertebra, which is the first bone in the spine beneath the skull, has epidural attachments (ligament attachments) that anchor this bone into the outer layer of the spinal cord (dura). There are also specialized ligaments called dentate ligaments that anchor the dura into the actual spinal cord fibers themselves. The pair of these ligaments are the shortest and thickest, arranged horizontally at the level of the atlanto-axial joint (C1-C2).
Physical trauma seen in snowboarding falls, military explosions, and car accidents cause injuries to the neck that result in neurological stress on the spinal cord. These types of accidents are extremely common in a community like Colorado Springs where we are seeing more cases of trigeminal neuralgia than usual.
When this part of the upper neck shifts even by just half a degree, it can tether (stretch) the spinal cord and disrupt information coming into the trigeminal nucleus which again, is the densest region of sensory overlap in the entire trigeminal nerve pathway. Due to the convergence of information in this region, faulty stimulation into the nucleus has no way of sorting if it’s coming from the face or the neck. What the brain does in response is puts priority on the face and interprets or perceives pain in the face as opposed to the neck. I believe this to be an adaptive survival mechanism the brain innately performs in order to protect vitally important senses that happen in the face.
What This Means For TN?
Degenerative conditions or misalignment of the upper cervical spine can relay nociceptive (painful) input into the brain from the nerves of the upper spinal cord. This input travels up the cord, through the trigeminal nucleus, and into the brain where the patient experiences facial and jaw pain due to the sensory overlap.
NUCCA chiropractors have had great success with patients suffering from trigeminal neuralgia by simply focusing on correcting the alignment and integrity of the upper neck. What is unique, is that a NUCCA chiropractor is not actually treating the trigeminal neuralgia. In comparison to traditional chiropractors and medical management where treatment is given for relief of secondary conditions (symptoms), chiropractors specialized in specific techniques of the cranio-cervical junction like foundational correction will perform a comprehensive examination including digital imaging to locate the exact degree of the shift or misalignment in this region. This x-ray analysis allows the practitioner to deliver a gentle, non-invasive correction to remove the tension and pressure on the spinal cord and nerves without any popping or twisting of the neck. Through an initial phase of correction the patient will begin to hold normal alignment over time for a more permanent solution to their problem.
This approach focuses simply on removing the interference in the nervous system and subsequently the trigeminal nerve that occurs due to stress and trauma of the upper neck. In turn, normal communication and accurate information to the brain is restored neurologically. This safe and effective procedure has helped hundreds of patients with trigeminal neuralgia in Colorado Springs and across the country experience relief of their debilitating symptoms. If you or someone you know has exhausted health care options for something as debilitating as trigeminal neuralgia, advise them to consider seeking help from a NUCCA chiropractor. It may be their saving grace.
To learn more about how our Colorado Springs Chiropractors have helped patients recover from trigeminal neuralgia at Balance Chiropractic, simply call 719–265–0115 or visit www.balancecolorado.com to schedule a no-obligation complimentary consultation.
[1] https://www.sciencedirect.com/science/article/pii/001448866190036X
