Case Report: Cranial Adjustments and Trigeminal Neuralgia

Cranial and Chiropractic Care in Chronic Trigeminal Neuralgia

A Review of Pederick (2005)

Trigeminal neuralgia — often called “tic douloureux” — is one of the most severe facial pain conditions known in clinical practice. It is characterized by sudden, electric-shock-like pain along one or more branches of the trigeminal nerve.

A 2005 case report by Frank Pederick, published in the Chiropractic Journal of Australia, explored whether cranial and spinal chiropractic adjustments could provide conservative relief for chronic trigeminal neuralgia.

Trigeminal neuralgia involves irritation or dysfunction of cranial nerve V. Pain typically:

• Is unilateral (one-sided)

• Occurs in brief, intense bursts

• May be triggered by chewing, talking, or light facial contact

Conventional medical management includes anticonvulsant medications, analgesics, surgery, radiosurgery, TENS, acupuncture, and other modalities (Zakrzewska & Linskey, 2014). However, long-term relief is not always achieved, and side effects can be significant.

The Case: Six Years of Recurrent Pain

In Pederick’s case report, the patient had experienced right-sided trigeminal neuralgia for six years. Her history included:

• Periods of remission following dental or medical intervention

• Recurring exacerbations

• A recent two-month flare-up with continuous pain

Before chiropractic intervention, she rated her pain at 9.5/10 on a visual analogue scale (VAS).

The treatment approach included:

• Cranial adjustments

• Spinal chiropractic adjustments

After four consultations over 11 days, the patient’s reported pain decreased dramatically to 0.5/10.

While a single case report cannot establish causation, the magnitude and rapidity of improvement were notable.

Possible Mechanisms

Cranial and upper cervical adjustments may influence trigeminal neuralgia through several mechanisms:

• Modulation of trigeminal nucleus activity

• Reduction of mechanical irritation at the cranial base

• Improved cervical biomechanics

• Altered afferent sensory input

The trigeminocervical complex — a neurological convergence zone between upper cervical nerves and the trigeminal system — provides a plausible anatomical explanation for why cervical interventions might affect facial pain (Bogduk, 2001).

Additionally, manual therapy has been shown to influence pain modulation pathways and central sensitization mechanisms (Bialosky et al., 2009).

Clinical Implications

Pederick (2005) suggested that cranial and spinal adjusting:

• Offers a conservative, low-cost, low-technology option

• Does not preclude other treatments if ineffective

• May require occasional maintenance care

Importantly, the author positioned chiropractic care as an initial conservative approach rather than a replacement for medical management.

A Balanced Perspective

While encouraging, this report represents Level IV evidence (single case study). Larger controlled trials are needed to:

• Establish effectiveness

• Clarify mechanisms

• Identify appropriate patient selection criteria

Nevertheless, for patients seeking non-pharmacological options, conservative chiropractic care may represent a viable adjunct or early intervention strategy.

Cranial Adjustments and Trigeminal Neuralgia: Conclusion

The 2005 case report by Pederick contributes to a growing conversation about conservative management of trigeminal neuralgia. In this case, cranial and spinal chiropractic adjustments were associated with dramatic short-term pain reduction in a chronic sufferer.

As always in integrative care:

Conservative approaches that are low risk and reversible may serve as reasonable first-line options — provided patients are properly evaluated and co-managed when necessary.

References

Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model. Man Ther. 2009;14(5):531–538.

Bogduk N. The anatomy of occipital neuralgia. Clin Exp Neurol. 2001;38:121–127.

Pederick F. Cranial and other chiropractic adjustments in the conservative treatment of chronic trigeminal neuralgia: A case report. Chiropr J Aust. 2005;35:9–15.

Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ. 2014;348:g474.

Cranial and Other Chiropractic Adjustments in the Conservative Treatment of Chronic Trigeminal Neuralgia: A Case Report, Pederick, F. Chiro J Aust, 2005; 35:9-15.

ABSTRACT : Trigeminal neuralgia, sometimes called tic douloureux , is characterized by episodes of electric-shock-like pain in areas of the face where branches of the trigeminal nerve are distributed. Medical treatment includes pharmaceuticals, analgesics, surgery, radiosurgery, low-powered lasers, TENS, acupuncture and biofeedback. Manipulative approaches have been used successfully in a medical center in China, and reports of successful treatment with chiropractic techniques have been published. The patient in this report had a history of right-sided facial pain, diagnosed as trigeminal neuralgia, over a 6-year period with remissions after dental or medical treatment and exacerbations, the most recent of 2 months duration. Prior to cranial and other chiropractic adjustments, the patient had continuous pain that she rated at 9.5 on the visual analogue scale, and after 4 consultations over an 11-day period, pain had reduced to 0.5. Spinal and cranial adjusting potentially affects a wide range of causes of trigeminal neuralgia and offers a conservative, low-cost, low technology initial approach which, if ineffective, will not greatly delay or inhibit other treatment. Occasional maintenance care may be required in some instances to reduce occurrences.