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Best Trigeminal Neuralgia Treatment in Delhi

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What is Trigeminal Neuralgia ?

Trigeminal neuralgia (TN) is a chronic pain condition that affects the trigeminal nerve (also known as the fifth cranial nerve), which carries sensation from your face to your brain. It’s notorious for causing sudden, severe, shock-like facial pain.

Causes of Trigeminal Neuralgia

The exact cause of trigeminal neuralgia is not always known, but in the vast majority of cases (up to 95%), it is linked to compression of the trigeminal nerve.

  • Vascular Compression (Classical Trigeminal Neuralgia): This is the most common cause. A blood vessel (usually an artery, less commonly a vein) presses on the trigeminal nerve where it exits the brainstem. Over time, the pulsating of the blood vessel can wear away the protective myelin sheath around the nerve, causing it to misfire and send abnormal pain signals.
  • Secondary Trigeminal Neuralgia: In some cases, TN can be a symptom of an underlying medical condition that damages or compresses the trigeminal nerve. These include:
    • Multiple Sclerosis (MS): This autoimmune disease damages the myelin sheath of nerves, including the trigeminal nerve.
    • Tumors or Cysts: A growth or fluid-filled sac can press on the nerve.
    • Arteriovenous Malformation (AVM): An abnormal tangle of arteries and veins can compress the nerve.
    • Facial or Dental Trauma/Injury: While less common, direct injury to the face or complications from dental procedures can sometimes trigger TN.
    • Stroke: In rare instances, a stroke affecting the brainstem can lead to trigeminal neuralgia-like pain.
  • Idiopathic Trigeminal Neuralgia: When no clear cause can be identified,  it is referred to as idiopathic TN.
Symptoms of Trigeminal Neuralgia
  • Pain Characteristics:
    • Severe, Sharp, Stabbing, or Electric Shock-like: The pain is often described as a lightning bolt or electric shock.
    • Brief but Frequent Attacks: Attacks typically last from a few seconds to about 2 minutes, but can occur in rapid succession, sometimes hundreds of times a day.
    • Unilateral: The pain usually affects only one side of the face. In rare cases, especially with MS, it can be bilateral (affecting both sides), but usually not at the same time.
  • Location: The pain occurs along the distribution of one or more of the trigeminal nerve’s three branches:
    • Ophthalmic (V1): Forehead, eye, upper eyelid.
    • Maxillary (V2): Upper jaw, cheek, upper teeth, nose.
    • Mandibular (V3): Lower jaw, lower teeth, lip.
    • Most commonly, the pain affects the V2 and V3 branches.
  • Triggers: Even a light touch or mild stimulation to specific “trigger points” on the face can provoke an attack. Common triggers include:
    • Touching the face (e.g., washing, shaving, applying makeup)
    • Eating, chewing, swallowing
    • Talking, smiling
    • Brushing teeth
    • A cool breeze or air conditioning
    • Head movements or vibrations (e.g., walking, riding in a car)
  • Periods of Remission: Patients may experience periods of remission where the pain subsides completely for weeks, months, or even years, before returning. However, in severe cases, attacks can be continuous.
  • Atypical Pain (Type 2 TN): Some individuals may experience a more constant, dull ache, burning, or throbbing sensation, which may or may not be accompanied by the sharp, shooting pains. This is sometimes referred to as atypical trigeminal neuralgia.
Advanced Physiotherapy for Trigeminal Neuralgia
  • Improve range of motion (ROM) in the cervical spine and jaw: Restricted movement in these areas can sometimes exacerbate nerve irritation or contribute to referred pain.
  • Promote relaxation and stress management: Chronic pain can lead to increased stress, which can worsen symptoms.
  • Cervical Spine Assessment and Treatment:
    • Assessment: Thorough examination of the neck (cervical spine) for stiffness, postural imbalances, muscle tightness, and any signs of nerve impingement or referred pain. The trigeminal nerve connects with the upper cervical spine, and dysfunction here can sometimes influence facial pain.
    • Exercises:
      • Cervical Range of Motion (ROM) Exercises: Gentle movements of the neck in all planes (flexion, extension, rotation, lateral flexion) to improve flexibility and reduce stiffness.
      • Chin Tucks/Cervical Retraction: Exercises to improve deep neck flexor strength and posture.
      • Shoulder Blade Stabilization: Exercises to improve posture and reduce strain on neck and shoulder muscles.
  • Temporomandibular Joint (TMJ) Assessment and Treatment:
    • Assessment: Evaluating jaw movement, muscle tenderness, and any clicking or locking of the TMJ. Patients with TN often clench their jaw due to pain.
    • Exercises: Gentle jaw exercises to improve opening, closing, and lateral movements, reducing muscle tension around the jaw.
  • Soft Tissue Mobilization and Release:
    • Myofascial Release: Techniques applied to the muscles and fascia of the face, jaw, neck, and shoulders to release tension, reduce trigger points, and improve circulation.
    • Trigger Point Therapy: Direct pressure on specific tender points in muscles that may be contributing to or exacerbating pain.
  • Neural Mobilization:
    • While direct mobilization of the trigeminal nerve itself is complex and rarely done in the same way as peripheral nerves, techniques that promote overall nerve health and mobility in the neck and upper body can be beneficial. This might involve gentle glides of the cervical nerves.
  • Modalities:
    • Heat or Cold Therapy: Applying heat packs to tense muscles or cold packs for acute pain relief.
    • TENS (Transcutaneous Electrical Nerve Stimulation): May provide temporary pain relief by interfering with pain signals.
    • Low-Level Laser Therapy (LLLT): May help with pain modulation and tissue healing.
    • Posture Correction: Advice on ergonomic adjustments and maintaining good posture to reduce strain on the cervical spine and related structures.
Manual Therapy Techniques for Trigeminal Neuralgia
  • Cervical Mobilization:
    • Gentle Mobilizations: Applying gentle, rhythmic movements to the cervical vertebrae to restore normal joint play, reduce stiffness, and improve nerve mobility. These are not high-velocity thrust manipulations initially, especially in patients with acute pain, but rather careful, graded oscillations.
    • Traction: Manual or mechanical traction to the cervical spine can help decompress nerve roots and reduce muscle spasm.
  • Soft Tissue Techniques:
    • Direct Myofascial Release: Applying sustained pressure or stretching to release tight fascial restrictions in the suboccipital region, temporalis, masseter, sternocleidomastoid, and trapezius muscles.
    • Trigger Point Pressure Release: Applying sustained pressure to active trigger points in the facial and neck musculature to reduce pain and muscle hypertonicity.
    • Deep Tissue Massage: To alleviate muscle tension and improve local circulation in the neck and shoulder girdle.

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