Arterial Compression for Trigeminal Neuralgia

This is a nice summary article published in 2020 that discusses trigeminal neuralgia (TN).^[1]

Often people with TN are told their pain is due to arterial compression on the trigeminal nerve.

There are several studies^[2],[3],[4] that show many people have arterial compression without TN symptoms, however. Much like many people with disc bulges or herniations have no back pain.

How could this be?

My theory is that the subnucleus caudalis (SC), a nucleus of the trigeminal nerve responsible for reporting pain and temperature to the brain, extends down to the second or third level of the cervical spine (C2,3).

This happens to be the area where the levator scapula (a muscle that runs from the shoulder blade to C1-4) inserts.

When the shoulder blade is not working properly –which is quite common — stress is delivered via the levator scapula to the cervical vertebrae where the SC resides.

This indirectly delivers stress to this structure and triggering TN symptoms. Of course, this is the only cause of symptoms.

Blood vessels pressing on the trigeminal nerve certainly may be another cause or they both may occur together.

If the blood vessel pressure were the only cause of TN, surgery to correct this should have a higher success rate than the 70% as reported in the Araya et al article mentioned at the beginning of this post.

It also isn’t clear how success is defined here i.e. 100% permanent resolution of symptoms, resolution for 6 months, etc.

As I’ve mentioned earlier, I’ve only treated a handful of these patients and so do not have substantive numbers of cases to support my claim.

I’ve found it very difficult to convince doctors to send these cases to me — likely due to the belief that arterial compression is the sole source of TN symptoms.

However, all three of the cases I have treated had 90-100% resolution of symptoms in a relatively short period of time. To my knowledge, those symptoms have not returned.

If my theory is correct though, it shows that a systems-approach to solving pain should be considered for this group of patients.

This means solving the musculoskeletal stressors contributing to pain first to resolve the problem. If that does not solve all the pain, then surgery to reduce arterial compression could be considered. I believe this would improve the surgical outcomes.

If you have any history of shoulder or upper body trauma/injury/surgery, you may be having TN due to unresolved issues relating to those previous problems.

To see if the shoulder blades and, by extension, the levator scapula may be contributing to your TN symptoms, try this simple test.

Maintain the test for about 2 minutes if possible.

If you found the test to be positive in your case, my Fixing Your Headaches downloadable program is designed to solve the musculoskeletal problems contributing to neck pain and headaches quickly and easily.

I believe it will make a huge impact on your pain. Please keep in touch with me if you purchase it.

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^[1] Araya EI, Claudino RF, Piovesan EJ, Chichorro JG. Trigeminal Neuralgia: Basic and Clinical Aspects. Curr Neuropharmacol. 2020;18(2):109-119. doi: 10.2174/1570159X17666191010094350. PMID: 31608834; PMCID: PMC7324879.

^[2] Docampo J, Gonzalez N, Muñoz A, Bravo F, Sarroca D, Morales C. Neurovascular study of the trigeminal nerve at 3 t MRI. Neuroradiol J. 2015 Feb;28(1):28-35. doi: 10.15274/NRJ-2014-10116. PMID: 25924169; PMCID: PMC4757119.

^[3] Jani RH, Hughes MA, Gold MS, Branstetter BF, Ligus ZE, Sekula RF Jr. Trigeminal Nerve Compression Without Trigeminal Neuralgia: Intraoperative vs Imaging Evidence. Neurosurgery. 2019 Jan 1;84(1):60-65. doi: 10.1093/neuros/nyx636. PMID: 29425330; PMCID: PMC6500902.

^[4] Tanrikulu L, Hastreiter P, Bassemir T, Bischoff B, Buchfelder M, Dörfler A, Naraghi R. New Clinical and Morphologic Aspects in Trigeminal Neuralgia. World Neurosurg. 2016 Aug;92:189-196. doi: 10.1016/j.wneu.2016.04.119. Epub 2016 May 6. PMID: 27157289.