Bilateral Trigeminal Neuralgia - A Condition of the Upper Neck

Posted in Head Pain Disorders on Jan 31, 2022

Bilateral trigeminal neuralgia doesn’t fit into the standard definitions … that is until you realise how it is connected with the health of your upper neck. Then, it actually makes a lot of sense! Classic trigeminal neuralgia involves irritation to one of the branches of the trigeminal nerve causing pain either around the eye, across the cheek or along the jaw of one side of the face.

One of the most common causes of classic trigeminal neuralgia is where an enflamed blood vessel is pressing against the nerve, in which case a microvascular decompression surgery may be required. (Fortunately, as far as brain surgeries go, it is pretty safe with a good rate of recovery). However, there are many people who suffer trigeminal have had normal brain MRIs, which show that there is nothing actually wrong with the brain itself.

In addition, there are many people who experience mixed or bilateral trigeminal neuralgia, which occurs on either side of the face or involves more than one branch. If trigeminal neuralgia is a condition where something is pressing against the nerve, like a pebble in your shoe, this should not occur.

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Instead, what this means is that bilateral or mixed trigeminal neuralgia may instead be a functional nerve disorder, which means that something is affecting not the nerve itself, but the central processing centre where the nerve information is received. And as a result of irritation to the central processing centre, you can go on to experience a range of mixed or bilateral trigeminal neuralgia symptoms. Now, one of the most important things to do in this case is to rule out pathological disorders such as tumours, bleeding or multiple sclerosis, which all involve lesions that can affect the brain structure itself. If these things are present, they show up on MRI scans.

However, if you experience trigeminal neuralgia and your MRI scan is normal, this may mean that the cause of your symptoms is coming from somewhere else. And if so, one of the most important places you may need to look at is the health, structure and alignment of the vertebrae in your upper neck.

How does the upper neck affect trigeminal neuralgia?

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Many people with trigeminal neuralgia also experience a number of other symptoms including headaches, migraines, neck pain and jaw pain. However, they’ve never realised (perhaps until now) that they are connected. (Note: in my own experience, when people have 10 different symptoms in their body, it is most likely that they have only 1-2 things actually wrong that is producing 10 different effects than having 10 actual different problems happening all at once. It’s a simple matter of probability, but one that so many people including specialists forget about). So, how do we connect the dots?

Without getting too technical into neurology, let’s have a look at the relationship between the vertebrae in your upper neck and your brainstem. Let’s start with the vertebrae. The top vertebra in your neck is known as the C1 or atlas. It supports the weight of your skull (3-5Kg) and provides 50% of your total ability to move your head up and down. The second vertebra in your neck is known as the C2 or axis. It supports your atlas and provides 50% of your total ability to rotate your head side to side. In order to provide this amount of flexibility, your body needed to make a trade during development.

The atlas and axis are less stable, and thus more susceptible to physical injury. Not always fractures or dislocations (i.e., instability), but micro-tears in the ligaments that hold the vertebrae together can accumulate over time.  More on that later, but first we need to look at the connection between the atlas and axis and your spinal cord. In order to make sure that your spinal canal stays open and does not become compressed when you move your head, your body contains structures known as myodural ligaments. These ligaments act like tethers that anchor the spinal cord and the vertebrae in place so that no matter how you move your head, your spinal canal stays open.

That is under normal circumstances when the vertebrae are aligned and moving the way that they are supposed to. It is an entirely different story if either the atlas or axis are misaligned, even by a few millimetres, and not moving properly.  If this happens, they may produce a physical pulling on the spinal cord itself, which can produce pain and other issues.

Sensory overload and bilateral trigeminal neuralgia

Now, here’s the part that relates to bilateral trigeminal neuralgia. Remember that we mentioned the central processing centre that receives the pain and sensory information from the branches of the trigeminal nerve on the face? Well, this processing centre is located in the brainstem and actually descends into the upper neck to the level of the atlas and axis. The functional arrangement of the nerve out system is entirely too complex for anyone neuroscientist to ever comprehend. Nevertheless, we may appreciate computer processing information. If there is even one program that is faulty, or if the computer is corrupted with malware, the entire device starts to misbehave. 

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Similarly, if the central processing centre for the trigeminal nerves receives faulty or corrupted information, the entire system can start to misfire, which produces the sensation of pain or other problems potentially anywhere on the face. And here’s the thing: that central processing centre also receives a huge volume of information from the spinal nerves at the top of your neck from C1 down to the level of C4. These are the nerves that, when irritated, are so commonly associated with a wide range of headaches, migraines, neck, should and jaw pain.

If this information begins to spill over and gets jumbled into the same processing centres that receive the sensory information from the trigeminal nerves, it can produce a wide array of problems that includes bilateral trigeminal neuralgia. So we see in this illustration that a syndrome such as bilateral trigeminal neuralgia may actually have little, if anything to do with the nerve branches themselves, but may only be the end effect of a different type of condition coming from a mechanical and neurological issue with your upper neck.

If I have an upper neck problem causing bilateral trigeminal neuralgia, why doesn’t it show up on my MRI or CT scans?

At this point, many people with bilateral trigeminal neuralgia wonder how it can be possible to have a physical problem with the joints between their atlas and axis if that doesn’t show up on their MRI or CT scans either. The answer, in its simplicity, is bound to frustrate you. It is because no one was looking! Or if they were looking, they just weren’t looking always from the right angle.

Let me explain. MRIs, CTs and standard x-rays are taken from stock angles: front-to-back, side-to-side and top-to-bottom. This is ideal for identifying signs of pathology such as fractures, dislocations, lacerations, tumours, infections, lesions, arthritis, and so forth. However, when we’re talking about micro-damage to the ligaments, those don’t show up on the stock angles because they are too small. Now, don’t misunderstand me that small things don’t matter. They do! Take for example if you get an eyelash caught in your eye. An eyelash is only 0.15mm thick, and yet it can produce all kinds of discomfort! (BTW, sensory for the eyeball IS the trigeminal nerve!).

However, in order to see structures that are that small on standard imaging, it is necessary to look at things from different angles that are based on your individual body structure.  Again, let’s point out the obvious: you are a unique human being. You look different from everyone else in the world. And that means that those differences exist not just on the outside, but on the inside as well. Your atlas and axis vertebrae are not shaped exactly the same as everyone else. Therefore, when we’re talking able small misalignments only a few millimetres big, unless your scans are orientated in order to visualise your unique anatomy, it will never be possible to see them until the problems are so large that we would quantify them as true dislocations, which would then be an entirely different issue.

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This is one of the reasons why so many of these neck-related disorders are overlooked in bilateral trigeminal neuralgia. It is because they are perceived as being too small to be of any consequence; and because there aren’t any broken bones or dislocations, they can’t actually be the problem. The issue that we have with this is that this simply is not so.

The Blair Technique and bilateral trigeminal neuralgia

So many people with bilateral trigeminal neuralgia scour the internet and go from neurologist to neurologist and specialist-to-specialist looking for answers for their syndrome. It is not usually until they’ve dug just a little bit deeper than they discover what we are about to share with you that, in my opinion, really should be one of the first places that people with bilateral trigeminal neuralgia should go. This is to what is known as a Blair upper cervical chiropractor. The Blair Technique is one of a group of specific methods (similar to NUCCA and Atlas Orthogonal) known as upper cervical specific that focuses on the relationship between the atlas, the axis and the brainstem in conditions such as mixed or bilateral trigeminal neuralgia.

Unlike general spinal manipulations, the Blair Technique is a precise and personalised approach to treating neck conditions that do not involve any twisting, rotation or manipulation (i.e., no cracking) for the purpose of achieving the best possible outcome with the least amount of intervention. The Blair Technique was researched and developed in the USA, which is one of the reasons that it is still so rare here in Australia. Our practice, Atlas Health, is one of the only Blair healthcare centres in all of Australia, and we are the leading upper cervical centre in Brisbane. Located in North Lakes, our focus is helping people with health conditions such as trigeminal neuralgia improve their quality of life so that they can get back to enjoying the things that matter most to them.

We hope that this article has provided you with valuable information and hope. If you would like more information about how the Blair Technique may be able to help your trigeminal neuralgia, call us at 07 3188 9329 to schedule a consolation today. Alternatively, click the Contact Us link on this page, and our staff will return your email as soon as possible, We look forward to hearing from you, and it will be our pleasure to assist you.


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