The trigeminal nerve is the 5th cranial nerve and has 3 branches – Ophthalmic (top), maxillary (middle) and mandibular (bottom), see the diagram below. The sensory nucleus is in the upper neck and that is important as we shall see later.
The trigeminal nerve is the largest of the 12 cranial nerves. Its main function is transmitting sensory information to the skin, sinuses, and mucous membranes in the face. The nerve communicates touch, pain, and temperature to the brain.
The mandibular division also has motor function and stimulates movement of the muscles in the jaw and some of the muscles within the inner ear.
The trigeminal nerve can also be a source of intense pain for some people. This is part of a chronic condition called trigeminal neuralgia (TN). It happens when the trigeminal nerve is under pressure or irritated. TN is more common in women than men and in people over 50 (rare under 40)
In over 90% of cases, trigeminal neuralgia is thought to be caused by vascular compression of the trigeminal nerve.
The pain associated with trigeminal neuralgia can be very intense. People often describe it as a shooting or jabbing pain that lasts anywhere from a few seconds to several hours.
Pain can also be achy or burning. It tends to occur more often over time. Many things can trigger the pain, including touching the face, shaving, eating, yawning, or talking. It can affect one or both sides of the face. TN can cause long-term difficulties with chewing and speaking.
Medical treatment is usually anticonvulsants, antidepressants and muscle relaxants. The main drug of choice for the treatment of trigeminal neuralgia is carbamazepine
Sometimes surgery is needed to remove what’s irritating the trigeminal nerve. In other cases, injecting a numbing agent into the nerve can help.
What are the alternatives if you don’t want to go down the drug/surgery route or the side effects prohibit their use?
- Acupuncture. Some studies have shown that acupuncture appears more effective than pharmacotherapy or surgery. Data suggests that the side effects of acupuncture are less, it is safer and cheaper. There are some acupuncture protocols available on the NHS through the pain clinic but the wait is horrendously long. Talk to us at Walnut Grove as Dr Tong may be able to help.
- Vitamin B12 supplementation. This vitamin helps promote healthy nerve function. This is particularly important if you are vegetarian or vegan as you may have less of the vitamin in your system than you need.
- Omega 3. Fish oils or flaxseed oil, olive oil or nut oils may help strengthen your nerves and ease inflammation.
- Homoeopathy. Homoeopathy treats the constitution and symptoms rather than specific conditions. So, it is better to see a qualified homoeopath who will take a full medical history, rather than look up remedies on the internet. Give us a call at Walnut Grove to speak to Wendy, who can advise you further.
- St John’s wort. This is a herb that has been used for hundreds of years to treat depression and nerve pain. If you are on antidepressants, heart medication, anti-epileptics, anti-coagulants, anti-rejection drugs, HIV medication or the contraceptive pill, it may interact with these and is not suitable for use in these cases. It is not suitable for use in pregnant or breast-feeding mothers.
- Reduce stress. Stress can trigger an attack of trigeminal neuralgia so it is important to try and stay calm and reduce stress. Take a relaxing bath, have a massage, go to bed early and try not to have an over-hectic schedule. If you are feeling distressed due to your neuralgia, talk to your friends and family. Sharing how you feel might help to reduce your stress levels.
- A TENS machine might help, depending on the exact type of neuralgia you have. Transcutaneous electrical nerve stimulation is when small amounts of electricity are sent through the skin to block pain signals. They also encourage the production of endorphins, the body’s own natural painkiller. Talk to one of the physiotherapists at Walnut Grove if you need more information about TENS.
- Osteopathy. Anecdotally several of the osteopaths at Walnut Grove have had success with treating TN. Treatment of the neck may have an effect on the sensory nucleus of the trigeminal nerve (see diagram above). Sometimes patients who have had surgery get recurrences due to scar tissue and studies have shown osteopathic manipulation can help in these cases too. Give us a call if you would like more information.
This is a miserable condition to live with but there are some options available, give us a call if you need help or information.
