Trigeminal Neuralgia (TN) has been called the suicide disease . Tic douloureux has been called classical Trigeminal Neuralgia and is associated with a trigger spot that can elicit severe pain.  Sometimes the slightest touch or breeze can set off severe volleys of excruciating pain.

Diagnostic Blocks can often give amazing pain relief results and isolate a more specific diagnosis and lead to effective long term treatment. A Sphenopalatine Ganglion Block is diagnostic of autonomic nervous system involvement. Sphenopalatine Ganglion Neuralgia or Sluder’s Neuralgia can be easily mistaken for Trigeminal Neuralgia. Shenopalatine Neuralgia is also no as the Brain Freeze or Ice Cream Headache.

If the pain is significantly relieved with a trans-nasal Sphenopalatine Ganglion Block it is likely repeated blocks will successfully treat or eliminate the pain. The Sphenopalatine Ganglion (SPG) is found in the Pterygopalatine fossa along with the maxillary division of the Trigeminal Nerve and the Maxillary artery.  There is a extremely high success rate when patients learn to Self-Administer Sphenopalatine Ganglion Blocks.

The SPG is the largest parasympathetic Ganglia of the head but also has Cervical Sympathetic nerves from the Stellate Ganglion and the Cervical Sympathetic chain. It is often involved in Sympathetic Overload.  Patients who see benefit can be taught to Self-Administer SPG Blocks with cotton-tipped catheters thru their nose.  These have been called Miracle Blocks and were the subject of a book “Miracles on Park Avenue”

Many cases diagnosed as Trigeminal Neuralgia are actually Atypical Facial Pain. Trigeminal Neuralgia is most typical in middle aged women but can occur in either sex and at any age. Atypical Facial Pain is often associated with  a feeling of tightness,  squeezing or twisting of tissues.

Many patients will elicit pain from chewing, talking or brushing their teeth but this can be other causes. True Trigeminal neuralgia is usually sudden short stabbing, burning, lancinating or electrical lightning bursts of pain.

Irritation of the Trigeminal Nerve can be the culprit causing symptoms. This can be secondary to tooth extraction , an abscessed tooth, a sinus infection, vacuum sinusitis, TMJ or MPD disorder, Allergic inflammation in sinus  or other oral surgical procedures. It can be related to herpetic infection from herpes a or shingles..

In some instances there is nerve impingement. One very striking on is the patient who talks with virtually no movement of jaw or tongue. This may be secondary to a medial or medial posterior displacement of the TM Joint articular disc, This is rare and I have only seen one instance in over 40 years of practice. It can also be secondary to nerve entrapment as it passes thru a muscle. This type is frequently associated with myofascial pain and dysfunction or other musculoskeletal issues.

Myofascial pain can coexist with trigeminal neuralgia. It is typically dull, achy pain but can be extremely severe and intense. It is correlated with poor posture and maladaptive muscle function and repetitive muscle injuries. The Occipital Nerve in the neck can be impinged on in forward head posture patients creating pressure on the nerve and neuralgia like pains.  Frequently Occipital Nerve Blocks, Greater Occiptal or Lesser occipital nerve blocks can also help provide relief and aid in diagnosis.

Consider the analogy of hitting your Crazy Bone and feeling shooting pains down your arm, this would be an acute truama to the nerve. When you fall asleep on the couch and wake with your arm numb and tingly this is also a nerve injury but more chronic in nature. In a similar fashion there are many types of trigeminal pain but they are not neuralgias. Burning pain is often diagnostic of an inflamatory process or neuritis and burning.

Abnormal breathing or paradoxical breathing can cause compression of the cervical nerves that become the brachial plexus between the anterior and medial scalene muscles.  While typically these refer to shoulder, back, chest, neck and down the arms in some patients they refer pain to crania structures.

Misdiagnosis is extremely frequent in Trigeminal Neuralgia.  This often results in unnecessary root canal treatments and extractions if the TN diagnosis is missed and Severe problems with excessive medication with associated side affects if TN is made as an improper diagnosis.

These problems are often related to TMJ disorders and under-developed maxilla and small airways.

A diagnosis of “Trigeminal Neuralgia” is not always meaningful depending on the knowledge of the doctor making the diagnosis.  Tic douloureux is usually straight forward but Atypical Trigeminal Neuralgia is often a diagnosis of exclusion.