Upper Cervical Chiropractic for Trigeminal Neuralgia

Upper cervical specific care chiropractic is a natural approach to helping people suffering Trigeminal Neuralgia.

If you have been recently diagnosed with Trigeminal Neuralgia - or if you have been experiencing Trigeminal Neuralgia for a long time and you are looking for treatment options, you surely have a lot of questions:

• Are surgery and medication my only option?

• If my MRI scans are normal, why am I still experiencing the pain?

• How can a chiropractor help Trigeminal Neuralgia?

• I’ve already been to a physiotherapist (or chiropractor). How is this “upper cervical” treatment any different?

In this article, we will do our best to answer these common questions about upper cervical chiropractic treatment for Trigeminal Neuralgia.

Trigeminal Neuralgia - We believe in Hope.

Before we get into the details, we want to share with you just a few things that we, as Blair Upper Cervical Chiropractors, believe.

• We believe in the Innate Healing power that gives life to the human body.

• We believe that no matter who you are or what you are experiencing that as long as a you have a breath of life in your body, that there is hope and that you do have the ability to heal.

Trigeminal neuralgia is no exception to this rule. Yes, trigeminal neuralgia is one of the very cruelest syndromes that any human being can endure. And believe it or not, trigeminal neuralgia is actually far more common that you would otherwise believe. You are not alone in this.

And most fortunately, we have been able to help many people over the years experiencing trigeminal neuralgia. We have been able to help them find relief and get back to enjoying the things in life that matter most to them.

You are not your pain, and we know that healing is possible.

Of course, every human being is different, and so we will not be so stupid to promise you the world without at least meeting you and assessing your unique circumstances first. Nevertheless, we do know that healing from Trigeminal Neuralgia is possible.

Trigeminal Neuralgia - What your neurologists or specialists may not have told you

Okay, this is not an article about the “types” or categories or Trigeminal Neuralgia: classic, atypical type, I, II, III and so forth. Specifically, this is an article for people who are experiencing the idiopathic type of Trigeminal Neuralgia.

In other words, you are experiencing the head and facial pain (the exact location doesn’t really matter, and we will explain why in just a few

moments), but your MRI scans appear normal. This means that your specialists and neurologists can’t identify the exact cause of your symptoms.

And if you are an intelligent, logical human being, this will not make any sense to you.

How can it be possible that you can experience the symptoms so fierce as Trigeminal Neuralgia but there isn’t any “cause” showing up on your tests?!

We believe in a cause an effect universe. All effects have a cause, and all causes have effects. Now, in fairness, when people experience symptoms, we don’t always know what the true underlying cause is. Nevertheless, there are two general categories that we can discuss that relate to Trigeminal Neuralgia.

The first is what is known as “objective pathology.” Things like a tumour, an infection, a bleed, a other discrete lesion (e.g., rubbing against an artery or nerve) that are clearly observable. Think of it like a frayed wire inside your computer that is causing it to malfunction. These types of lesions are the traditional things that trigeminal neuralgia specialists are commonly looking for. However, these types of conditions only account for approximately 50% of Trigeminal Neuralgia cases.

The second type is what is known as “functional pathology.” Think of it like a computer virus. You can’t see it, but something is affecting how the software works, and can still cause the computer to malfunction. In these cases, when you perform an MRI scan, everything will appear normal … and yet there can still be a major problem!

In these cases, the only tool that many neurologists or specialists for Trigeminal Neuralgia have are increasingly powerful drugs and medications. While many of these medications can often help to reduce the symptoms of trigeminal neuralgia, many of them also have side effects.

And if you are the type of person who doesn’t like taking drugs, this is not a palliative options … especially if you know that the drugs are simply masking the symptoms but aren’t getting to the underlying cause.

It is at this point when people typically start exploring other options for Trigeminal Neuralgia:

• To understand what the cause of trigeminal neuralgia is

• To understand what trigeminal neuralgia treatments are available that don’t involve drugs to surgery

• To understand what they need to do to get back to enjoying life!

The role of the upper neck in Trigeminal Neuralgia

When many people research trigeminal neuralgia, they focus on the three primary nerve divisions - the Ophthalmic, the Maxillary and Mandibular Nerves - of the Trigeminal Nerve. As a result, they focus on treatments on the head, face and teeth.

But let me ask you, where do you think all those nerves (which are like messengers on a road) ultimately travel? Yes, into the brain, but more specifically where? Where is the primary processing centre for all of the touch, pain, and temperature related information from the trigeminal nerve.

It is a centre known as the “Spinal Trigeminal Nucleus,” which is located in the brainstem (pone and medulla) … and that actually descends all the way into the spinal canal in the upper neck.

The reason that this orientation matters as it relates to trigeminal neuralgia is that any problem that affects the Spinal Trigeminal Nucleus may have the potential to produce the symptoms of trigeminal neuralgia.

In other words, Trigeminal Neuralgia isn’t always caused by a problem in the head or brain. It can also be caused by a problem in the upper neck!

There are three primary ways that a mechanical issue in the upper neck can actually lead to Trigeminal Neuralgia.

1. Mechanical tension. The top three vertebrae in your neck (C1, C2 and C3) contain ligaments that anchor the bone, surrounding muscles, and the outside of the spinal cord. Therefore, if the vertebrae move or get locked into the wrong position, they can exert a physical pull on the spinal cord, cause deformation, and thus produce a wide array of symptoms including trigeminal neuralgia.

2. Information overload. The joints in the upper neck also transmit a huge volume of information about your shoulders, neck and head. If these joints are injured, they can send an abnormal cascade of noxious information that overwhelms the sensory processing centre. Like a computer processing too much information all at once, this can cause the system to break down and even “spill over” to produce the symptoms of original neuralgia.

3. Fluid pressure. If the top vertebrae in the neck misalign and get locked in the wrong position, they can inferrer with the normal flow of blood and fluid to, from and within the cranial vault. The consequence is that fluid can build up and produce pressure or irritation on the nerves, which has been linked with a number of chronic pain and neurological disorders related with trigeminal neuralgia.

What is the take-away message here?

It is that a mechanical problem with your upper neck can affect the function of your nerve system and lead to a functional pathology such as Trigeminal Neuralgia.

… But what it also means is that the reverse can also be true. If the original cause is actually coming from your neck, then the solution for your trigeminal neuralgia may also involve the neck as well!

The Blair Technique and Trigeminal Neuralgia

Because the upper neck is such a sensitive and important area, it is important that any treatment is just as precise.

This is one of the major points of difference in what is known as the Blair upper cervical technique. The Blair technique is a specific method of chiropractic researched and developed in the USA (which is one of the reasons why it is still so rare here in Australia). It is similar it many ways to the NUCCA and Atlas Orthogonal techniques.

Unlike general spinal manipulation that may use twisting or cracking the neck, or other physiotherapeutic methods that involves trigger points, stretching or reading the muscles in the back of the neck, the Blair technique uses a completely different method of analysis that is actually based on your unique body structure.

Every human being is different on both the outside and also on the inside. So when it comes to getting the most precise and effective solutions, it is important to take these individual differences into account. Otherwise, you can be working in the right area … but in the completely wrong direction!

(It is one of the reasons if you have had different types of treatment for your upper neck but found that the treatment stirred up your trigeminal neuralgia that happened. Right area, but wrong way).

In order to minimise the chance of error and to maximise the chance of success, what a Blair upper cervical chiropractor does are a series of physical, neurological and diagnostic images that show what CTs and MRIs do not: they show the exact direction and degree of the displacement in your neck that is disrupting the normal life and healing flow between your brain and your body.

With this information, a Blair chiropractor is then able to perceive a personalised care recommendation, and perform a series of corrections, designed just for you, to restore and repair the normal alignment and movement through your upper neck. The principle here is that by restoring the function through the upper neck that it also restores the normal function of your nerve system to heal itself, the byproduct being a natural, drug-free and surgery-free option for trigeminal neuralgia.

As we have stated earlier in this article, every human being with trigeminal neuralgia is different. Therefore, before we would make any recommendations, we would simply advise having a conversation so that we may be able to answer any questions that you have to decide if Blair upper cervical care may be right for you.

References

Cruccu G, Finnerup NB, Jensen TS, et al. Trigeminal neuralgia: New classification and diagnostic grading for practice and research.

Neurology. 2016 Jul 12;87(2):220-8. doi: 10.1212/WNL.0000000000002840.

Epub 2016 Jun 15. https://www.ncbi.nlm.nih.gov/pubmed/27306631

Grgić V. [Influence of manual therapy of cervical spine on typical trigeminal neuralgia: a case report]. [Article in Croatian] Lijec Vjesn. 2010 Jan- Feb;132(1-2):21-4. https://www.ncbi.nlm.nih.gov/pubmed/20359155

Piovesan EJ, Kowacs PA, Oshinsky ML. Convergence

of cervical and trigeminal sensory afferents. Curr Pain Headache Rep. 2003 Oct;7(5):377-83. https://www.ncbi.nlm.nih.gov/pubmed/12946291

Vadokas V, Lotzmann KU. [Craniomandibular disorders and the cervical spine syndrome as differential diagnoses in suspected idiopathic trigeminal neuralgia.]. [Article in German] Schmerz. 1995 Jan;9(1):29-33. https:// www.ncbi.nlm.nih.gov/pubmed/18415496

Velásquez C, Tambirajoo K, Franceschini P, et al. Upper Cervical Spinal Cord Stimulation as an Alternative Treatment in Trigeminal Neuropathy. World Neurosurg. 2018 Jun;114:e641-e646. doi: 10.1016/j.wneu.2018.03.044. Epub 2018 Mar 14. https://www.ncbi.nlm.nih.gov/pubmed/29548953

Burcon M. Resolution of trigeminal neuralgia following chiropractic care to reduce cervical spine vertebral subluxations: a case study. J Vert Sublux Res 2009:1-7

Flory T, Chung J, Ozner J. Resolution of Facial Neuralgia Following Reduction of Atlas Subluxation Complex: A Case Study. J Upper Cervical Chiropr Res 2015:6-13

Grochowski J. Resolution of trigeminal neuralgia following upper cervical chiropractic care: a case study. J Upper Cervical Chiropr Res 2013:20-24

Rodine RJ, Aker P. Trigeminal neuralgia and chiropractic care: a case report. J Can Chiropr Assoc 2010;54(3):177–186

Zielinski E, Acanfora M. Resolution of trigeminal neuralgia following subluxation based chiropractic care: A case study & review of literature. A Vert Sublux Res 2013:33-45

Eriksen K, Rochester BP, Hurwitz EL. Symptomatic Reactions, Clinical Outcomes and Patient Satisfaction Associated with Upper Cervical Chiropractic Care: A Prospective, Multicenter, Cohort Study. BMC Musculoskeletal Disorders 2011, 12:219 doi:10.1186/1471-2474-12-219. https://link.springer.com/article/10.1186/1471-2474-12-219

Should you see a Chiropractor if you have a Chiari Malformation?

One of the two most common things that people diagnosed with a Chiari Malformation are told is that a) “Drugs and surgery are your only treatment options.” or b) “You just have to live with it.”

Because it is the brainstem that is involved, many people also have a degree of apprehension or fear about having anyone touch their neck, especially a chiropractor. However, what many people (including many neurologists and specialists) don’t realise is that there are many different types of chiropractors.

Foremost, not all chiropractors twist or crack the neck. In fact, there is a special division of chiropractic known as Upper Cervical Chiropractic and the Blair Technique that focuses exclusively on the delicate relationship between the vertebrae of the upper neck and the brainstem.

The Blair Technique, which was developed and researched in the USA (but is still exceptionally rare here in Australia), is a unique approach to healthcare that has a long history of helping people with complex conditions including Chiari Malformation.

The Blair Technique is a precise, natural and specific method of chiropractic care that does not use any manipulation, twisting or neck cracking. The procedure involves a series of customised physical, neurological and diagnostic tests that reveal the exact location, direction and degree of misalignment in your neck. With this information, a Blair doctor of chiropractic then prescribes a personalised care recommendation, designed just for you, to help correct any underlying misalignments in your upper neck, which may thereby reduce the nerve pressure and tension associated with the Chiari Malformation.

If you or a loved one has recently been diagnosed with having a Chiari Malformation, the Blair technique may be a natural treatment option that doesn’t involve drugs or surgery that may be able to help improve your quality of life.

What Causes a Chiari Malformation?

Now, you are likely wondering what the relationship is between a Chiari Malformation and a misalignment of the vertebrae in your upper neck … let alone how the Blair upper cervical technique may be able to help you.

A Chiari Malformation happens when a portion of the brain or brainstem bulges outside of the skull and into the upper part of the spinal canal.

Also known as “cerebellar ecotopia,” a Chiari Malformation can produce a wide array of neurological symptoms:

• headaches

• migraines

• vertigo

• dizziness

• chronic fatigue

• neck pain

• chronic body pain

• brain fog

• insomnia

• dysautonomia*

(*The processing centres associated with heart, lung and digestive function are all located in the brainstem and transmit to your organs via the vagus nerve).

The cause of Chiari Malformations is frequently a combination of genetics, osteological and neurological development. In brief, it is the shape of the base of the skull that can make people more susceptible to suffering symptoms associated with a Chiari Malformation, but then it is a combination of other factors including physical injury of the lower neck (e.g., whiplash) that can cause the underlying problem to become particularly problematic … but more on that later.

A Chiari Malformation is diagnosed from a brain MRI, which shows exactly where the brainstem is bulging outside of the cranial vault.

• A Type I Chiari Malformation descends into the upper cervical spinal canal by at least 5mm to the level of the C1 vertebra (aka atlas vertebra)

• A Type II Chiari Malformation descends into the cervical canal by at least 8mm between the level of the C1 and C2 vertebra (aka axis vertebra)

• A Type III Chiari Malformation descends into the spinal canal below the level of the C2 vertebra.

There is also an even more common type known as a Type Zero Chiari Malformation that is less than 5mm in size, but still produce all the same types of lifer-disrupting symptoms.

If I have pain, can I have a Chiari Malformation even when my neurologist says that everything is normal?

One thing that is important for people diagnosed with a Chiari Malformations is that Chiari Malformations are measured according to size but not according to severity.

For people suffering the symptoms associated with a Chiari Malformation, it is important to understand that neurologists and specialists and traditionally trained to think that it is the size and location of pathology that matter most. However, when we take a step back to actually consider the sensitivity of the nervous system, we may better appreciate that even very small problems can produce severe, life disrupting symptoms.

Consider the analogy of getting an eyelash or a speck of dust caught in your eye. An eyelash is approximately .15mm thick, and dust particles are even smaller. Yet, how unpleasant is it when an eyelash or dust gets caught in your eye? Quite painful actually! That is the sensitivity of your nerve system when there is an abnormal source of irritation.

From the traditional perspective, a Chiari Malformation is not believed to be clinically significant until it is at least 5mm in size. And yet, if 0.15mm is more than enough to produce significant pain and nerve irritation, it is essential to appreciate that even very small problems can cause disproportionately large effects.

It also means that when people experiencing symptoms associated with Chiari Malformation, just because your MRI tests come back as being “normal” does not mean that things are actually normal.

What it may actually means is that you need more information and another opinion from a qualified professional, who knows to take even small problems into proper consideration.

What is the connection between an Atlas Misalignment and a Chiari Malformation?

Many people who suffer symptoms all associated with a Chiari Malformation (e.g., headaches, migraines, dizziness, vertigo and chronic pain) have been to neurologists and specialists. However, they have not explored the possibility that the symptoms could be associated with a misalignment in the upper neck.

The missing link may be what are known as myodural ligaments. Myodural ligaments are unique slips of connection tissue found in only place in the body: the upper cervical spine. These ligaments anchor your brainstem and spinal cord within your spinal canal so that the nerves do not get crushed when your move your head.

The atlas vertebra (C1) is responsible for approximately 50% of your total head movement: up-and-down and also side-to-side. The total amount of movement of the atlas vertebra is typically 10-20mm.

Normally, when the atlas is properly aligned and moving properly, the myodural ligaments protect the brainstem. However, if the atlas is not aligned and offset by even 0.5mm, these ligaments do not protect, but can actually exert tension on the brainstem.

Think of a Chiari Malformation like a balloon with a string. The balloon is your brain, and the string is your spinal cord. If the atlas vertebra in your neck is misaligned, it can be like pulling on the string, which in turn pulls on the balloon. If the tension is great enough, it can even produce pressure that can cause the brainstem to bulge out into the spinal canal.

In this way, adverse mechanical tension as a result of a physical problem with the alignment of your upper neck may be one of the contributing factors that leads to the development of a Chiari Malformation.

If so, the reverse may also be true: that a precise mechanical correction of the alignment of the atlas may help to reduce the pressure and relieve the symptoms associated with the Chiari Malformation

Blair Upper Cervical Chiropractic and Chiari Malformation

For people suffering with brainstem pressure, migraines, vertigo or other symptoms associated with a Chiari Malformation, one of the most important things that can you do to improve your quality of life is schedule a visit to see a Blair upper cervical specific chiropractor.

At Atlas Health, we believe that life and healing come from within. We believe that no matter who you are or what you have experienced, you can heal. Our purpose is to help people with complex health conditions including Chiari Malformation find relief so that you can enjoy the things in life that matter most to you. The way that we help people is through the power of Blair upper cervical chiropractic care, which is a unique, precise and personalised approach to healthcare that focuses on restoring the life flow between the brain and the body.

Dr Jeffrey Hannah is an advanced certified Blair upper cervical chiropractor. He is an international speaker, published author and recognised leader in the special field of upper cervical specific chiropractic care. Our practice located in North Lakes (north Brisbane) provides the highest quality in upper cervical chiropractic care for the Brisbane, Gold Coast and Sunshine Coast communities.

To find out how Blair upper cervical care may be able to help you or your loved ones back back to enjoying the full quality of life that you deserve, contact our office at 07 3188 9329 or click the Contact Us link on this page, and one of our staff will return your email as soon as possible.

References

Bidari A, Ghavidel Parsa B, Ghalehbaghi B. Challenges

in fibromyalgia diagnosis: from meaning of symptoms to fibromyalgia labeling. Korean J Pain. 2018 Jul;31(3):147-154. doi: 10.3344/kjp.2018.31.3.147. Epub

2018 Jul 2. https://www.ncbi.nlm.nih.gov/pubmed/30013729

Bragée B, Michos A, Drum B, Fahlgren M, Szulkin R, Bertilson BC. Signs of Intracranial Hypertension, Hypermobility, and Craniocervical Obstructions in

Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Front Neurol. 2020 Aug 28;11:828. doi: 10.3389/fneur.2020.00828. PMID:

32982905; PMCID: PMC7485557. https://pubmed.ncbi.nlm.nih.gov/ 32982905/

Flanagan MF. The Role of the Craniocervical Junction in Craniospinal Hydrodynamics and Neurodegenerative Conditions. Neurol Res Int.

2015;2015:794829. doi: 10.1155/2015/794829. Epub 2015 Nov 30. PMID:

26770824; PMCID: PMC4681798. https://pubmed.ncbi.nlm.nih.gov/ 26770824/

Freeman MD, Rosa S, Harshfield D, Smith F, Bennett R, Centeno CJ, Kornel E, Nystrom A, Heffez D, Kohles SS. A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash). Brain Inj.

2010;24(7-8):988-94. doi: 10.3109/02699052.2010.490512. PMID: 20545453.

https://pubmed.ncbi.nlm.nih.gov/20545453/

Hulens M, Rasschaert R, Vansant G, et al. The link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome: exploration of a shared pathophysiology. J Pain Res. 2018 Dec 10;11:3129-3140. doi: 10.2147/JPR.S186878. eCollection 2018. https:// www.ncbi.nlm.nih.gov/pubmed/30573989

Ibrahimy A, Huang CC, Bezuidenhout AF, Allen PA, Bhadelia RA, Loth F. Association Between Resistance to Cerebrospinal Fluid Flow Near the Foramen Magnum and Cough-Associated Headache in Adult Chiari Malformation Type I. J Biomech Eng. 2021 Jan 16. doi: 10.1115/1.4049788. Epub ahead of print. PMID: 33454731.https://pubmed.ncbi.nlm.nih.gov/ 33454731/

Rosa S, Baird JW. The craniocervical junction: observations regarding the relationship between misalignment, obstruction of cerebrospinal fluid flow, cerebellar tonsillar ectopia, and image-guided correction. Smith FW, Dworkin JS (eds): The Craniocervical Syndrome and MRI. Basel, Karger, 2015, pp 48-66 (DOI:10.1159/000365470).

Van Oosterwijck J, Nijs J, Meeus M, Paul L. Evidence for central sensitization in chronic whiplash: a systematic literature review. Eur J Pain. 2013 Mar;17(3):299-312. doi: 10.1002/j.1532-2149.2012.00193.x. Epub 2012 Sep

https://www.ncbi.nlm.nih.gov/pubmed/23008191