TRIGEMINAL NEURALGIA

MIGRAINES
CERVICAL PAIN

MASTER CLASS 2013

MACRO-ANATOMY
 Neuralgias of the head
Facial Neuralgias

Trigeminal Neuralgia

Atypical Trigeminal Neuralgia

Atypical Facial Pain

Anesthesia Dolorosa

Cluster headaches

Tension headaches

Sinus headaches

Migraine headaches with or

without aura

Cephalgia
 HOW TO TREAT?

Regional neuropathic pain syndrome

of the

Trigeminal, Facial and Cervical nerves

TRIGEMINAL NERVES
FACIAL NERVE
POSTERIOR SUPRACLAVICULAR NERVE
OCCIPITAL NERVES
 Encyclopedia
Anatomica 1771
Nerves involved in
Trigeminal
Neuralgia,
headaches, sinusitis
and migraines

John Marshall (1883):

Neuralgia is most likely
where the nerves leave
the bony or fibrous
framework or around
bones
GRAY ANATOMY
 Grays
Anatomy
of the
Facial
nerve and
branches
FACIAL-TRIGEMINAL ANASTOMOSIS
Spalteholz
Anatomy
Trigeminal
Facial
Cervical
nerves
Hebbs postulate
(1949):
nerves that fire
together, wire
together
Encyclopedia Anatomica: Right Facial nerve
Hiltons law (1863):
The joints and muscles acting on them and the overlying skin share a nerve
supply
CERVICAL PLEXUS LASTS ANATOMY
Superficial nerves neck Lasts Anatomy
The Greater Auricular nerve (C2-3) anastomosing with
the Facial nerve (VII) provides its perineurium with
Nervi Nervorun (sensocrine innervation)
The Greater Auricular nerve (C2-3) anastomosing with the
Facial nerve (VII) provides its perineurium with Nervi
Nervorum (sensocrine innervation)
 Punctus Nervosum on the
posterior supraclavicular nerve
is a prime headache Trigger Point
Trigeminal Nerve
Paired cranial nerve with three major branches:

Ophtalmic nerve (V1)

Maxillary nerve (V2)

Mandibular nerve (V3)

Facial Nerve and Artery
Lasts Anatomy
 Trigeminal Nerve Divisions I, II & III
Lasts Anatomy, ninth Edition, McMinn
STEP ONE:
Palpate and mark the pain sites on
the three (3) Trigeminal foramen
V1,V2,V3. Then inject 0,5 ml of
DW5 with a 30G inch needle

STEP TWO
Mark all the tender spots
along the trigeminal nerve
branches. Inject these tender
sites using 0.5 ml of D5W.
If completely pain-free, pathology
is caused by a pure Trigeminal Nerve
involvement. If not completely pain-
free, consider a mix Facial ,Trigeminal
and Cervical Neuralgia and proceed to
Step Three.
STEP THREE
Locate and palpate gently for the
tender spots along the five
major Facial and/or Cervical
nerve branches
 Differential Diagnosis
of Craniofacial Pain
Primary and secondary headache disorders
Ophthalmologic
Ear, nose, and throat
Sinus disorders
Teeth and jaw (TMJ)
Oral cavity and salivary glands
Craniocervical
Neoplasia (intra/extra-cranial)
Psychogenic (DSM-IVR)
Trigeminal Neuralgia Patients Treated
with Neural Proloterapy
Ferrara, Italy 2011
Dr Steven Cavallino

The Italian Twelve

 The Italian Twelve
7/12 were actual Trigeminal Neuralgias (V2-V3)
Only 1/7 also showed pain in opthalmic branch
(V1)
Neural Prolotherapy Injection Sites
in Facial Neuralgia

Red Trigeminal Nerve Injection Sites (V1,V2, V3)

Yellow Temporal Nerve Injection Sites

Blue Facial Nerve Injection Sites

The Italian Twelve
All 12
patients
showed an
immediate
pain relief
following
initial NPT
treatment
 The Italian Twelve
Patients returned weekly for a total of 3 NPT treatments

9 /12 patients (75%) showed less pain and decreased

frequency after first treatment with NPT ( DW5)

The pain scale was 3/10 after one week and was 1/10 after the
second week

The remaining 3 patients (25%) that were still 6/10 after one
treatment needed more attention and treatment. After 3
treatments they were 1/10.
Christchurch Thirteen
From August 2011
 Christchurch Thirteen
All thirteen had an immediate and complete resolution of their pain
Two patients with an isolated Trigeminal neuralgia.
One patient with a 30 year Hx of TN after dental work did not want to
continue after two treatments, too difficult.
One patient, age 72, with a 9 year Hx of TN of the Maxillary branch after
chiropractic manipulation, had lasting relief after two treatments but was
diagnosed with disseminated Ca breast and hasnt returned.
One 9 year old girl with a 18 month Hx of chronic frontal and parietal
headaches following headers in a game of football, had instant relief, but this
didnt last. She fractured her Tibia during the treatment period and was in a
great deal of associated pain and disability. BMI very high.
Six patients with stinking headaches resolved with one treatment.
Four mixed TN, Facial, Cervical neuralgias responded instantly.
One female patient age 48 with a 20 year Hx of TN has come back every
month and is without medication.
One female patient age 42 with a 30 year Hx of TN returned after 4 months
of no headaches and requested a top-up, just in case.
One female patient age 45 with a lifelong Hx of TN has been back 3 times
since August and is no longer on any medication.
One female patient, age 36, had instant relief but did not return. too painful
Christchurch three with sinus pain
One male patient, age 48, had three previous sinus
operations, but still with pain and snorting and sniffing.
Wife C/O his snoring. Has had two Rxs and reports no
more sinus pain, wife happy and not sniffing
anymore. Treatment of all TN branches and some Facial
branches
One male patient, age 36 with 2 previous sinus
operations, but still with sinus pain responded with one
treatment of TN I and II.
One female patient with a Hx of 3 previous operations
was lost to follow up. TN 1 and II were treated.