Trigeminal Neuralgia: What is it and what is the role of physiotherapy

What is Trigeminal Neuralgia

Trigeminal neuralgia is a condition that causes severe, stabbing and recurring facial pain. This condition occurs when the trigeminal nerve which is responsible for transmitting sensory impulses from the face to the brain is irritated or compressed.

The trigeminal nerve is one of 12 pairs of cranial nerves that exit directly from the brain and help regulate facial sensation and movement. This nerve is divided into three main branches, namely the first trigeminal nerve (V1) which regulates the eye and forehead area, the second trigeminal nerve (V2) which regulates the cheek and nose area, and the third trigeminal nerve (V3) which regulates the mandible and lip area.

In trigeminal neuralgia, one or more branches of this nerve become overactive or compressed, resulting in an exaggerated response to normal stimuli such as light touch or wind. This causes severe pain that can last from a few seconds to several minutes.

Symptoms of Trigeminal Neuralgia

Symptoms of trigeminal neuralgia usually include:

1. Sharp, throbbing, or stabbing pain in the face, usually on only one side of the face.
2. Recurrent attacks of pain without symptoms between attacks (intermittent).
3. Pain that can be triggered by mild stimulation such as brushing teeth, eating, talking or simply touching certain parts of the face.
4. Some patients may experience pain-free periods (remissions) before attacks recur.

Causes of Trigeminal Neuralgia

The exact cause of trigeminal neuralgia is not completely understood. However, this condition is often accompanied by compression or irritation of the trigeminal nerve, leading to impaired nerve signal transmission and severe pain. Several factors can cause or contribute to trigeminal neuralgia, including:

1. Blood vessels that press on the trigeminal nerve
   • One of the most common causes of trigeminal neuralgia is when blood vessels near the trigeminal nerve press on it. This pressure irritates the nerves and causes pain.

2. Multiple sclerosis (MS)
   • In some cases, MS sufferers experience trigeminal neuralgia. MS is an autoimmune disease in which the body's immune system attacks the protective coating around the nerves (myelin), which can affect the trigeminal nerve.

3. Tumor
   • Tumors pressing on the trigeminal nerve can cause trigeminal pain.

4. Head injury
   • Head injury or facial trauma can damage the trigeminal nerve and cause severe pain.

5. Inflammation
   • Inflammation around the trigeminal nerve, such as from an infection or other disease, can cause trigeminal pain.

6. Aging process
   • Trigeminal neuralgia is more common in older people, especially those over 50 years of age, but is not limited to this age group.

Sometimes the cause of trigeminal neuralgia cannot be determined precisely, and the condition is called idiopathic trigeminal neuralgia. Although the above factors may contribute to the development of trigeminal neuralgia, the exact mechanisms that cause abnormalities in the trigeminal nerve are not completely understood. Trigeminal neuralgia is believed to be a multifactorial condition.

Mechanism of Trigeminal Neuralgia

Mekanisme neuralgia trigeminal mengacu pada gangguan saraf trigeminal yang menghasilkan respon nyeri berlebihan terhadap rangsangan normal. Meskipun mekanisme ini belum sepenuhnya dipahami, beberapa teori dan faktor penyebab telah diidentifikasi. Mekanisme yang terlibat dalam trigeminal neuralgia adalah:

1. Trigeminal Nerve Compression
   • The main factor associated with trigeminal neuralgia is pressure or compression of the trigeminal nerve. This pressure can be caused by blood vessels near the nerve pressing on the trigeminal nerve, or other structures, such as a tumor or swelling, pressing on the nerve

2. Nervous system hypersensitivity
   • Trigeminal nerve disorders can cause hypersensitivity, which makes the nerve more responsive to normal stimuli that usually do not cause pain. Mild stimuli such as a light touch, wind or facial movement can trigger severe pain.

3. Myelin Degeneration
   • Myelin is a protective layer that covers nerve fibers and helps transmit nerve signals. If myelin is damaged, nerve signals can be disrupted and cause pain symptoms.

4. Inflammation
   • Inflammation in the area of the trigeminal nerve can cause nerve irritation and damage, contributing to trigeminal neuralgia.

5. Multiple sclerosis (MS)
   • Some cases of trigeminal neuralgia occur in people with MS, an autoimmune disease that destroys neuromyelin in various parts of the nervous system.

The Role of Physiotherapy in Trigeminal Neuralgia Cases

Physiotherapy can play an important role in the treatment of trigeminal neuralgia, which aims to reduce pain, improve facial function and improve the sufferer's quality of life. Although physiotherapy cannot cure trigeminal neuralgia directly, it can help relieve symptoms and help sufferers overcome the condition. The following are some physiotherapy tasks for cases of trigeminal neuralgia:

1. Relieves pain and muscle tension

The physiotherapist will use various physiotherapy modalities to relieve pain and reduce muscle tension in the facial area. This may help reduce the symptoms of trigeminal neuralgia and increase patient comfort.

2. Relaxation exercises

A physiotherapist  can teach relaxation techniques to relieve stress and muscle tension that can cause trigeminal attacks.

3. physical training

A Physiotherapist  knows how to plan a safe fitness program tailored to individual needs. These exercises can help maintain flexibility and strength of facial muscles and improve balance, which can be beneficial for people with trigeminal neuralgia.

4. Postural care

Better head and neck posture can help relieve pressure on the trigeminal nerve and reduce the risk of pain attacks.

5. Training and self-management

A physiotherapist can provide self-management education and strategies to reduce factors that cause trigeminal pain, such as: eating carefully, avoiding excessive facial stimulation, and maintaining good oral hygiene.

6. Transcutaneous Electrical Nerve Stimulation (TENS):

A physiotherapist can use TENS to send mild electrical impulses through the skin to relieve pain in the affected area of the face.

Physiotherapy treatment should be tailored to the patient's individual situation and performed with care to avoid triggering painful attacks. Physiotherapy is usually part of a comprehensive treatment regimen when treating trigeminal neuralgia. Doctors and other health professionals may also be involved in overall treatment planning to help people manage this condition and improve their quality of life.

Also read: Tingling, Pain and Numbness in the Hands? Get to know some of the causes

Reference :

1. Gunawan, P.Y., Dina, A. 2018. Trigeminal Neuralgia  Etiologi, Patofisiologi, dan Tatalaksana. MEDINICUS. Vol:7(2). 53-60
2. Kesanda, I M P.,  Putr,  B P S, Wiratama, B K., 2022. Neuralgia Trigeminal. Ganesha Medicina Journal. Vol:2(2). 129-136
3. Iro H, Bumm K, Waldfahrer F. Rehabilitation of the trigeminal nerve. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2005;4:Doc12. Epub 2005 Sep 28. PMID: 22073060; PMCID: PMC3201012. https://pubmed.ncbi.nlm.nih.gov/22073060/
4. Claypool, A., Wong, C K. 2023. Role of Physical Therapy in Trigeminal Neuralgia: A Case With 4-Year Follow-up. JOSPT Cases 2023;3(2):119–126. Epub: 13 April 2023. doi:10.2519/josptcases.2023.11446