Abstract

Introduction: Trigeminal neuralgia is sudden-onset, sharp, stabbing, and recurrent pain that is provoked by trigger factors within the distributed branch area of the trigeminal nerve. Although surgical intervention, which primarily comprises micro vascular decompression (MVD), and medication are mainstream treatment options to relieve pain, the indication and efficacy of these approaches depend on each case. Recently, tenderness in the greater occipital nerve area in patients with craniofacial pain has been reported, indicating a vital role of nociceptive afferents with the involvement of trigeminal branches through the trigeminocervical complex (TCC). Here, we present two improved cases of trigeminal neuralgia with parietal acupoint therapy (PAPT) by treating the muscle stiffness of the posterior cervical region.
Case Reports: In Case 1, a 64-year-old female who presented with right typical trigeminal neuralgia symptom with posterior cervical muscle stiffness and occipital numbness on the same side. Remarkably, her pain was triggered by head flexion. The unusually dilated greater occipital artery was suspected to be associated with the greater occipital nerve (GON) stimulation, resulting in the exacerbation of pain during head flexion. The pain was effectively controlled with parietal acupoint therapy and occipital nerve block (ONB). In Case 2, a 63-year-old female presented with trigeminal neuralgia after dental treatment with the posterior cervical muscle stiffness. Three cycles of PAPT performed once a week completely relieved her muscle stiffness and trigeminal pain without medication.
Conclusions: The nociceptive stimuli from the posterior cervical region are vital contributory factors to initiate trigeminal neuralgia. This report reveals that relieving the posterior cervical muscle stiffness by parietal acupoint therapy for the treatment of trigeminal neuralgia is effective. Hence, this noninvasive treatment for trigeminal neuralgia should be considered before prescribing medication or performing surgical interventions.

Keywords: Trigeminal neuralgia; Posterior cervical stiffness; Nociceptive stimuli; Trigeminocervical complex; Parietal acupoint therapy