Trigeminal Neuralgia : Physiotherapy

Trigeminal Neuralgia

Introduction :-

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain.

You may initially experience short, mild attacks. But trigeminal neuralgia can progress and cause longer, more-frequent bouts of searing pain. Trigeminal neuralgia affects women more often than men, and it’s more likely to occur in people who are older than 50.

Because of the variety of treatment options available, having trigeminal neuralgia doesn’t necessarily mean you’re doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia with medications, injections or surgey


Trigeminal Nerve

Illustration showing branches of the trigeminal nerve
Trigeminal neuralgia symptoms may include one or more of these patterns:

(1)Episodes of severe, shooting or Tabbing pain that may feel like an electric shock
(2)Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking or brushing teeth
Bouts of pain lasting from a few seconds to several minutes
(3)Episodes of several attacks lasting days, weeks, months or longer — some people have periods when they experience no pain
Constant aching, burning feeling that may occur before it evolves into the spasm-like pain of trigeminal neuralgia
(4)Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead
Pain affecting one side of the face at a time, though may rarely affect both sides of the face
(5)Pain focused in one spot or spread in a wider pattern


In trigeminal neuralgia, also called tic douloureux, the trigeminal nerve’s function is disrupted. Usually, the problem is contact between a normal blood vessel — in this case, an artery or a vein — and the trigeminal nerve at the base of your brain. This contact puts pressure on the nerve and causes it to malfunction.

Trigeminal neuralgia can occur as a result of aging, or it can be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Trigeminal neuralgia can also be caused by a tumor compressing the trigeminal nerve.

Some people may experience trigeminal neuralgia due to a brain lesion or other abnormalities. In other cases, surgical injuries, stroke or facial trauma may be responsible for trigeminal neuralgia.


The first line of treatment is medication.
The drug of choice is carbamazepine (Tegretol™), which eliminates or brings acceptable pain relief in 69 percent of patients.
Baclofen (Lioresal™) is the second drug of choice and may be more effective if used with low-dose carbamazepine.
Other medications that may be effective include pimozide, phenytoin (Dilantin™), capsaicin, clonazepam (Klonopin™) and amitriptyline (Elavil™).

Surgical procedures:-

(1)Percutaneous trigeminal radiofrequency rhizotomy
This procedure selectively destroys pain-causing nerve fibers while preserving touch fibers.
Lesioning techniques include radiofrequency thermocoagulation, glycerol injection and mechanical trauma. They are used for patients who are poor candidates for major surgery.
Complications can include weakness in chewing, facial numbness, changes in tearing or salivation and, less often, corneal ulcers, severe aching pain (anesthesia dolorosa) or meningitis.

(2)Microvascular decompression of the trigeminal nerve
This surgical technique involves microsurgery to move the vessel, causing compression away from the trigeminal nerve.
Relief is often long lived; however the incidence of facial numbness is much less than in selective rhizotomy and anesthesia dolorosa does not occur.
The procedure is best for patients younger than 65 with no significant medical or surgical risk factors.
Possible complications include asceptic meningitis, with head and neck stiffness; major neurological problems, including deafness and facial nerve dysfunction; mild sensory loss; cranial nerve palsy, causing double vision, facial weakness, hearing loss; and, on very rare occasions, postoperative bleeding and death.
Microvascular decompression brings complete relief to 75 percent to 80 percent of patients. The recurrence rate is 5 percent to 17 percent.

Physiotherapy Management:-

Physiotherapy Treatment Trigeminal Neuralgia

*The aims of physiotherapy management:-
To decrease pain and functional limitation, and to improve quality of life.
Treatments include the use of electro-physical agent to relieve pain during acute onset.
Manual therapy, exercise therapy for Temporomandibular Joint (TMJ) as well
as self-massage for facial muscles can also help to restore patients’ functions.
Transcutaneous electrical nerve stimulation (TENS) currently is one of the
most commonly used forms of electroanalgesia

Interferential Therapy(IFT)

Interferential therapy (IFT) is another electro-physical modality commonly used
for pain management in clinical situations. IFT is the application of alternating
medium frequency current (4,000 Hz) with amplitude modulated at low
frequency (0–250 Hz). Several theoretical physiological mechanisms such as
the gate-control theory, increased circulation, descending pain suppression,
block of nerve conduction, and placebo have been proposed in the literature to
support the analgesic effects of IFT reducing pain for patients with trigeminal neuralgia by having them received
fifteen sessions of IFT with treatment duration of thirty minutes. The intensity of
the impulse varied according to patient’s tolerance. The results suggested that
IFT could be considered as one of the electro-physical modalities in reducing
pain for trigeminal neuralgia.

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