Trigeminal Neuralgia / Fothergill’s Disease (FD)

Fothergill’s Disease (FD) also known as Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain.

TN usually occurs when the myelin sheath of the trigeminal nerve has been worn away, sometimes due to a blood vessel causing compression to the nerve, or if the patient has Multiple Sclerosis, a disease that attacks the myelin sheath.

Trigeminal neuralgia is manifested by severe, paroxysmal facial pain. The classical type involves compression of the trigeminal nerve root. Sodium-channel blockers are the first-choice treatment; if they are unsuccessful, vascular decompression or ablative procedures may be used.

What is the main cause of trigeminal neuralgia?
The main cause of trigeminal neuralgia is blood vessels pressing on the root of the trigeminal nerve. This makes the nerve transmit pain signals that are experienced as stabbing pains. Pressure on this nerve may also be caused by a tumor or multiple sclerosis (MS).
What is the best treatment for trigeminal neuralgia?
The anticonvulsant drug most commonly prescribed for trigeminal neuralgia is carbamazepine (Tegretol), which can provide at least partial pain relief for up to 80 to 90 percent of patients. Other anti-convulsants prescribed frequently for trigeminal neuralgia include Phenytoin (Dilantin) Gabapentin (Neurontin).
How painful is trigeminal neuralgia?
Trigeminal neuralgia (TN), also known as tic douloureux, is sometimes described as the most excruciating pain known to humanity. The pain typically involves the lower face and jaw, although sometimes it affects the area around the nose and above the eye.
Is trigeminal neuralgia serious?
Trigeminal neuralgia is the most common cause of facial pain and is diagnosed in approximately 15,000 people per year in the United States. Trigeminal neuralgia pain is exceptionally severe. Although the condition is not life-threatening, the intensity of the pain can be debilitating.
How do I calm my trigeminal nerve?
Many people find relief from trigeminal neuralgia pain by applying heat to the affected area. You can do this locally by pressing a hot water bottle or other hot compresses to the painful spot. Heat a beanbag or warm a wet washcloth in the microwave for this purpose. You can also try taking a hot shower or bath.
What is the best painkiller for neuralgia?
Medications prescribed may include antidepressants such as amitriptyline or nortriptyline, which are effective in treating nerve pain. antiseizure medications such as carbamazepine, which is effective for trigeminal neuralgia. short-term narcotic pain medications, such as codeine.
Can trigeminal nerve repair itself?
The good news is that the vast majority of these peripheral trigeminal nerve injuries undergo spontaneous regeneration. However, some injuries may be permanent with varying degrees of sensory impairment ranging from mild numbness (hypoesthesia) to complete anesthesia.
How do you sleep with neuralgia?
The best way to sleep with occipital neuralgia is in a position that does not place more pressure on the nerves. Following are some guidelines: Sleep on your back. Use a pillow that supports the neck and keeps the head aligned with the body (neutral position).
Is trigeminal neuralgia caused by stress?
This facial pain typically does not follow anatomical boundaries or is explainable by present-day neurophysiological understanding. The pain is often constant with no remission and is aggravated by stress.
What foods to avoid if you have trigeminal neuralgia?
It’s important to eat nourishing meals, so consider eating mushy foods or liquidizing your meals if you’re having difficulty chewing. Certain foods seem to trigger attacks in some people, so you may want to consider avoiding things such as caffeine, citrus fruits, and bananas.
What is Type 2 trigeminal neuralgia?
Type 2 trigeminal neuralgia (TN2) is characterized by constant pain. Characteristically, in TN1, the pain isn’t constant; it comes and goes, and can be set off by touching the skin. It’s not uncommon for a person with TN1 to stop combing their hair or brushing their teeth.
What is the latest treatment for trigeminal neuralgia?
Botox -This is a medication that can be injected into muscles that block the nerve input to muscles and help tightness, spasm, and pain. Gamma Knife -This procedure uses the same machine used to treat tumors. A focused beam of radiation is directed at the root of your trigeminal nerve. Jul 28, 2020
Can you see trigeminal neuralgia on an MRI?
Brain magnetic resonance imaging (MRI) with and without contrast helps to distinguish secondary causes of trigeminal neuralgia (TN) from the idiopathic form. This study is an imaging modality of choice and indicated in patients presenting with trigeminal neuralgia when younger than 60 years, principally to exclude tumor.
How do you calm nerve pain?
Treating Nerve Pain
  1. Topical treatments. Some over-the-counter and prescription topical treatments — like creams, lotions, gels, and patches — can ease nerve pain. …
  2. Anticonvulsants. …
  3. Antidepressants. …
  4. Painkillers. …
  5. Electrical stimulation. …
  6. Other techniques. …
  7. Complementary treatments. …
  8. Lifestyle changes.
What can be mistaken for trigeminal neuralgia?
Additional investigation may reveal multiple sclerosis (MS), a tumor in the posterior fossa, or a tumor on the trigeminal nerve. Acoustic neuromas, cerebral aneurysms, trigeminal neuromas, and meningiomas can produce syndromes similar to idiopathic trigeminal neuralgia.
Does B12 help with trigeminal neuralgia?
PHILADELPHIA—Vitamin B12 deficiency may cause isolated facial neuralgia, independent of trigeminal neuralgia and peripheral neuropathy, according to research presented at the 14th Congress of the International Headache Society. Treatment with B12 injections was found to alleviate the condition.
What vitamins are good for trigeminal neuralgia?
For this case study, I would like to recommend a supplement that contains the B complex of vitamins (B6 is in the form of pyridoxine-5-phosphate 25mg ). The B vitamin contains B3 (25mg), B1 (15mg) B2 (15mg) and B5 (50mg).
Is CBD good for trigeminal neuralgia?
Evidence suggests that cannabinoids may prove useful in pain modulation by inhibiting neuronal transmission in pain pathways. Considering the pronounced antinociceptive effects produced by cannabinoids, they may be a promising therapeutic approach for the clinical management of trigeminal neuralgia.


Trigeminal neuralgia symptoms may include one or more of these patterns:

  • Episodes of severe, shooting, or jabbing pain that may feel like an electric shock
  • Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking, or brushing teeth
  • Bouts of pain lasting from a few seconds to several minutes
  • Episodes of several attacks lasting days, weeks, months, or longer — some people have periods when they experience no pain
  • A constant aching, burning feeling that may occur before it evolves into the spasm-like pain of trigeminal neuralgia
  • Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead
  • Pain affecting one side of the face at a time though may rarely affect both sides of the face
  • Pain focused in one spot or spread in a wider pattern
  • Attacks that become more frequent and intense over time

When to see a doctor

If you experience facial pain, particularly prolonged or recurring pain or pain unrelieved by over-the-counter pain relievers, see your doctor.


In trigeminal neuralgia, also called tic douloureux, the trigeminal nerve’s function is disrupted. Usually, the problem is contact between a normal blood vessel — in this case, an artery or a vein — and the trigeminal nerve at the base of your brain. This contact puts pressure on the nerve and causes it to malfunction.

Trigeminal neuralgia can occur as a result of aging, or it can be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Trigeminal neuralgia can also be caused by a tumor compressing the trigeminal nerve.

Some people may experience trigeminal neuralgia due to a brain lesion or other abnormalities. In other cases, surgical injuries, stroke, or facial trauma may be responsible for trigeminal neuralgia.


A variety of triggers may set off the pain of trigeminal neuralgia, including:

  • Shaving
  • Touching your face
  • Eating
  • Drinking
  • Brushing your teeth
  • Talking
  • Putting on makeup
  • Encountering a breeze
  • Smiling
  • Washing your face

Massage, Acupressure Points & Exercises for Trigeminal Neuralgia


Stretching nerves – whether it is the trigeminal nerve or the greater or lesser occipital nerve – cause a reflex effect allowing edema to exit the problematic nerve. This reduction of edema decreases the swelling of the nerve and improves its blood flow – resulting in improved function and reduced nerve pain.

Massage therapy may be beneficial for patients with nerve damage or tingling and burning sensations in the skin, hands, and feet. Caregivers may administer massage therapy, but a trained therapist can be more effective in pinpointing the proper areas and using the right amounts of pressure.

Can you rub out a pinched nerve?
A pinched nerve—the layman’s term for what doctors call a “compressed nerve”—can be very painful. There are self-care options, such as heat/ice, massage, and over-the-counter anti-inflammatory medications. If your pain has just started or if it isn’t too severe, you can try these.
Is it good to massage a pinched nerve?
Having a massage may also help reduce physical pain and stress. Applying gentle pressure around the affected area may help relieve tension, and a full body massage can help the muscles relax. Deep tissue massages may not be a good idea because the extra pressure may make the symptoms worse.

“Some individuals manage trigeminal neuralgia using complementary techniques, usually in combination with drug treatment.” Although they list low-impact exercise, yoga, and visualization among other approaches, there is no mention massage therapy. In my limited experience, massage therapy for TN has relieved everyone who has attempted it. From what I understand of this condition, it progresses over time. As the tissues become more compressed, the pain becomes more intense. If heat and massage can soften, mobilize, and relieve pain elsewhere in the body as it does, it can certainly relieve at least some of those cases of TN. It only makes sense to try therapeutic massage before administering drugs or performing surgeries.


  1. NIH Trigeminal Neuralgia Fact Sheet

Acupressure Points

For facial neuralgia, the protocol utilized local points of TH 17 and 21, GB2, SI 18, ST 2, 3 and 7, GV 26 and LI 20; systemic points included TH 5, LI 4, ST 36, ST 44, ST 45 and LIV 3. Auricular acupuncture points were also used (Shen Men, neuro, face, and lung points).


Does exercise help trigeminal neuralgia?
SMITH RESPONDS: Moderate exercise may improve pain symptoms in trigeminal neuralgia (TN), a neurologic condition that causes chronic facial pain. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head. TN is more common after the age of 40.

Desensitisation Exercises

Desensitization exercises are a way to retrain the skin and superficial tissues when there is hypersensitivity. For example, cotton wool can be stroked on the painful area for a minute a day, progressing to several times a day, as the skin and tissue adapt to the increased strength of the stimulus. After a while, the cotton wool can be replaced by a cotton cloth and eventually rougher fibers can be used.

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