삼차 신경통 및 목의 역할

에 게시됨 두부 통증 장애 ...에 06/26/2018 00:00 AM

Trigeminal Neuralgia is characterized as an intense stabbing pain of the face. Pain can be constant or come in random bursts. It can affect your eye, your nose, your upper mouth, your jaw, the side of your head, or combinations of them all. It can affect the left side of your face or the right or both.

Trigeminal Neuralgia affects 1 per 1000 people with over 1000 new cases diagnosed in Australia every year. This adds up to 3+ new cases every day. It is also the #1 most painful condition known to humankind. (As a comparison, natural childbirth ranks #4). It is for this unfortunate reason that it is also known as “the suicide disease.”

What is the Cause of Trigeminal Neuralgia?

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“Aetiology unknown.” If you search the Internet for the cause of Trigeminal Neuralgia, you will find this phrase. It means “cause unknown.” It is rare that the cause of Trigeminal Neuralgia is a tumor or infection. Because it is important to rule out these two dangerous possibilities, your GP or neurologist will usually recommend an MRI scan of your head.

However, most MRI comes back as normal. What this means is that the cause of Trigeminal Neuralgia is not pathological: it is functional. In other words, something is negatively affecting the way the nerve sends messages back to the brain.

The Common Approach to Trigeminal Neuralgia Treatment

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 To a degree, you can mentally block out the pain if you suffer a headache or backache. Trigeminal Neuralgia is a different monster altogether. Here is the great divide when it comes to treatment for Trigeminal Neuralgia.

The common approach is twofold: medication or surgery. The most common prescription is an extraordinarily strong CNS (central nervous system) depressant: usually Tegretol or Lyrica, which are also anti-epileptic drugs. The purpose of the medication is to block pain signals to the brain. However, there are usually two major problems:

  1. Head Fogginess. The medication doesn’t just block pain signals: it blocks all signals!
  2. The medication doesn’t work. Or you just end up taking more and stronger medication!

The next option is surgery. Some doctors believe that the cause of Trigeminal Neuralgia is a blood vessel or other structure compressing the branches of the Trigeminal Nerve. Like tumors or infections, this cause is also rare. Nevertheless, some neurosurgeons will recommend a. nerve ablation: aka destroying the nerve.

The problem with surgery, like medication, is that does not always work. Even the goto surgical procedure - microvascular decompression (MVD) - works only 50% of the time over a 15 year period. To be fair, a success rate of 50% is phenomenal! However, it means that there must be some other reason that Trigeminal Neuralgia exists for the other 50%. 

The Other 50%

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I have yet to meet any person who wants to take medication or have surgery if it is not necessary. When a lesion such as a tumor is pressing against the nerve, surgery may well be the best option. However, I do not believe that they should be the first treatment choice for Trigeminal Neuralgia.

Moreover when your MRI is normal - when there is no lesion to cause the pain - I am baffled why people believe that surgery or heavy medication will solve the problem. As I wrote previously, when the cause of Trigeminal Neuralgia is not due to a specific lesion, it means that the cause must be because something is disrupting the way the nerve sends messages back to the brain. And the problem very well may originate in your neck!

I presented to a local Trigeminal Neuralgia support group a few months ago. The meeting was attended people who have lived years, even decades with the pain of Trigeminal Neuralgia. In all honestly, these laypeople were more well-versed in all the different medications and surgeries that exist for Trigeminal Neuralgia than I was! To start my presentation, I asked the group what their neurologists and specialists had explained to them about the role of the upper neck is the development of Trigeminal Neuralgia.

I have to admit, even I was surprised that not one person said that they had ever seen a Trigeminal Neuralgia specialist speak one word about the role that the upper neck plays in the development of the condition. (After the presentation was complete, I did a Google search to see what the top organizations and support groups had to say about the role of the upper neck in the cause and treatment of Trigeminal Neuralgia.

Guess what I found? Practically nothing! There were plenty of articles describing the three branches of the Trigeminal Nerve itself … but nothing describing where the Trigeminal Nerve comes from within the brain … or what happens to a person if the nerve is affected at its root!)

The Role of the Upper Neck in Trigeminal Neuralgia

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From Gray's Anatomy. The big bulb (upper left) is the actual branches of the Trigeminal Nerve ... but look back where those nerves go: into that arc-shaped track that goes all the way to the bottom of the picture, which is where your neck starts! It also overlaps with lots of other nerves that also process information from your throat, internal organs, and brain.

The three parts of the Trigeminal Nerve - the Ophthalmic, Maxillary and Mandibular Nerves - are like branches on a tree that emerge from a common trunk and common roots. The root of the Trigeminal Nerve is called the Spinal Trigeminal Nucleus.

In the brain, a “nucleus” refers to any cluster of cells that do a certain activity. The Spinal Trigeminal Nucleus is a massive cluster that receives and processes all the sensory information from the branches of the Trigeminal Nerve. So where exactly is the Spinal Trigeminal Nucleus?

It extends from the brainstem inside the skull through the spinal cord all the way down to the level of the C3 vertebra in your neck. The implications of this basic biological fact are massive! It means that anything that negatively affects the atlas (C1), axis (C2) or C3 vertebrae in your neck has the potential to affect the Spinal Trigeminal Nucleus and in turn, trigger the symptoms of Trigeminal Neuralgia.

Experts propose several potential mechanisms of injury, the most likely being mechanical tension. Your brain and spinal cord are protected by a thick layer of connective tissue called the dura mater (no joke, the literal translation is “one tough mother”).

The dura attaches to the inside of the skull and the inside of the vertebral canal. In turn, the dura attaches to the cord via incredibly strong ligaments called dentate ligaments (aka “toothlike ligaments” because they are shaped like shark teeth).

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An astonishing fact is that the dentate ligaments in the upper neck are so strong that if there is sufficient tension on them, the brain tissue itself tears before these ligaments do! Why are these ligaments so strong? The function of the dentate ligaments is to maintain the position of your brainstem inside your spinal canal.

If these ligaments did not exist, you would compress your spinal cord every time that you moved your head. Experts believe it is this very protective mechanism that can cause the problems associated with Trigeminal Neuralgia. Specifically, the problem involves the top three vertebrae in the neck: C1 (the atlas), C2 (the axis), and C3.

 

References

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  3. Häggman-Henrikson B, Rezvani M, List T. Prevalence of whiplash trauma in TMD patients: a systematic review. J Oral Rehabil. 2014 Jan;41(1):59-68. doi: 10.1111/joor.12123. Epub 2013 Dec 30.
  4. Burgos-Vega C, Moy J, and Dussor G. Meningeal afferent signaling and the pathophysiology of migraine. Prog Mol Biol Transl Sci. 2015;131:537-64. doi: 10.1016/bs.pmbts.2015.01.001. Epub 2015 Feb 9.
  5. Losert-Bruggner B, Hülse M, Hülse R. Fibromyalgia in patients with chronic CCD and CMD - a retrospective study of 555 patients. Cranio. 2017 Jun 5:1-9. doi: 10.1080/08869634.2017.1334376.
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