Browsing articles tagged with " trigeminal neuralgia"

69. Occipital Headache, How Can Acupuncture Treat It?

Mar 7, 2017   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 8 (2), March, 2017, © Copyright

Jun Xu, M.D., Hong Su, C.M.D., Lic. Acup.

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

How Can Acupuncture treat Occipital Neuralgia?

 

Linda, a 45-year-old female dental assistant, came to me complaining of severe headaches that started at the back of her head and continued down a portion of her neck.  The pain also radiated up to her scalp, around her ears and sometimes into the bilateral temporal area.  The pain was off-and-on, but occurred every day.  The pain ranged from dull to sharp, and was sometimes located directly behind the right eye.  As a dental assistant, she constantly turned her head to the right when dealing with patients.  This caused the headache to become more severe, and she was frustrated that it interfered with her daily work.  She had consulted several doctors about her condition, and had been prescribed Naprosyn, Percocet and Neurotin, but none of them alleviated her condition.

These headaches intensified when Linda was under stress, which was often because of her job: if she had many patients waiting for her and felt under pressure, the headaches worsened.

When I examined Linda, I discovered that when I pressed her scalp at the base of the skull and suboccipital area, the pain radiated to the back, front and side of her head, and also to the right side of the eye.  When I pressed hard on the suboccipital area (the base of the skull) the pain was exacerbated and I could feel the bilateral temporal artery palpating.

The patient probably suffers from occipital neuralgia, which is a cycle of pain spasms originating in the suboccipital area, caused by an inflammation of the occipital nerves.  The two pairs of occipital nerves (each nerve contains a greater and lesser occipital nerve) originate in the second and third vertebrae of the neck.  These nerves supply areas of the skin along the base of the skull and behind the ear, but are not always connected directly with the structures inside the skull. However, they do interconnect with other nerves outside the skull and continue into the neuro-network.  Eventually they can affect any given area along the scalp, mainly on the bilateral temporal area behind the ear and sometimes connect to the nerve branch on either side of both eyes.

Occipital neuralgia may occur continuously, often as the result of the nerve impingement, especially from arthritis, muscle spasm, or as the result of a prior injury or surgery.  Sometimes these conditions will impinge the occipital nerve root, leading to severe headaches at the back of the head, leading to muscle spasm.  Linda exhibits the severe form of occipitical neuralgia, most likely because her profession causes her to tilt her head in the same manner for a good part of her day. This stress causes the occipital nerve to be impinged, sending a constant signal to the nerve network in her scalp, leading to headaches and the pain behind her right eye.

The clinical diagnosis of this condition is based on palpation by the doctor of the bilateral occipital nerve root, which will induce or trigger the headache. Doctors currently use various treatments.  One option is to inject 1% lidocaine 5cc into the occipital nerve root, which decreases or relieves the pain, confirming the diagnosis.  A second option is to use surgery to cut or burn the nerve with a radial wave probe.  A third option is to use a small injection of Botox or a similar medication.  Western medicines include anti-inflammatory or narcotics such as Percocet or Darvocet, Naurontin, anti-epilepsy medication, etc.  For the majority, these medications do not work well, though occasionally they can reduce the occurrence and frequency of the occipital neuralgia.

Some patients respond to physical therapy and massages to decrease the spasm of the neck muscle, which might temporarily relieve the occipital neuralgia.  Though doctors may recommend surgery, many patients resist this type of treatment.

According to Traditional Chinese Medicine, occipital neuralgia belongs in the category of the side headache, i.e. the Shao Yang Gallbladder meridian headache.  Gallbladder meridians are distributed around the sides of the head, and excessive heat in the gallbladder can lead to headaches.  The gallbladder meridian originates from the outside of the eye, and continues up the temporal nerve area, around the lateral skull area, down the occipital nerve area, down through the trunk and to the outside of the leg.  If there is excessive heat along this meridian, there will be an imbalance of yin and yang.  For example, if the patient undergoes stress, muscle spasm or arthritis, the nerve and the gallbladder meridian will be impinged.  This, in turn, will cause the gallbladder to heat up, leading to excessive heat, an imbalance of yin and yang and a severe headache.

Another meridian identified in occipital neuralgia by Traditional Chinese Medicine is the urinary bladder meridian, which starts from the inside corner of the eye, continues through the middle and the top of the scalp, and follows down the back of the trunk and into the back of the leg.  Due to the connection between the gallbladder and urinary bladder meridians, heat in one will cause heat in the other to rise, generating pain around the eye, the temporal area and the scalp, and making the ensuing headache severe and highly unbearable.  Therefore, the principal acupuncture treatment is to relieve this excessive heat in the gall bladder and urinary tract.

The main acupuncture points used for treatment are: Du 20 Bai Hui, GB 20 Feng Chi, GB1 Tong Zi Liao, GB 8 Shuai Gu, Extra point Tai Yang, GB 34 Yang Ling Quan, SI 3 Hou Xi, Lu 7 Lie Que, Kid 6  Zhao Hai, Li 3 Tai Chong.

Linda underwent my treatment three times a week for one month, resulting in immediate, short-term relief of her headaches.  However, the headaches continued to plague her because of her strenuous work.  In addition, her irregular menstrual cycle and hormonal changes led to more severe headaches.  Thus, I also treated her for hormonal changes by utilizing a Chinese herb Da Zhi Xiao Yao San.  The combination of acupuncture and herbal therapy seemed to be effective and, after about two months of treatment, Linda reported that her headaches occurred only infrequently and were very mild, and that she was satisfied with her treatments.

Usually, acupuncture, with or without the addition of herbal supplements, can alleviate the problems and pain associated with these headaches.  However, sometimes it is best to combine acupuncture with a nerve block (utilizing 4cc of 1% lidocaine plus 10 mg Kenalog mixed together) injected into both sides of the occipital nerve origin.  One month of this combined treatment should give the patient 95% relief from his/her symptoms.

Tips for acupuncturists:

  1. You should identify the location of the pain and tenderness, and treat the headache accordingly.  For example, the frontal headache belongs to the Yang Ming meridian; the temporal side headache belongs to the Shao Yang meridian; the top scalp headache belongs to the Jue Ying meridian.
  2. Always use Du 20 Bai Hui for all the different types of headaches. This is based on my personal experience over 20 years of practice.

Tips for patients:

  1. You should be very specific when describing the tender points on your head because each tender-point location belongs to a different meridian, and treatment varies based on each location.
  2. Massaging the Tai Yang and UB 20 Feng Chi points for 20 minutes, 2 to 3 times a day, will greatly decrease the headache.

 

67. Dr. Jun Xu’s calling from West Africa

Mar 5, 2017   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

Dr. Jun Xu went to Leprosy village in 2013, 2014 and 2016, soon he will go to the leprosy village on March 31, 2017.

In 2013, there was no a single room being used for treatment in the leprosy village, Dr. Xu and his team had to use a tent. The temperature was around 125 Fahrenheit degrees.

The leprosy patients were waiting for their turn to be attended. Dr. Jun Xu saw about 200 patients a day.

Typical leprosy patient:
Early Stages
Spots of hypopigmented skin- discolored spots which develop on the skin
Anaesthesia(loss of sensation) in hypthese opigmented spots can occur as well as hair loss
“Skin lesions that do not heal within several weeks of and injury are a typical sign of leprosy.” (Sehgal 24)

Progression of disease

“Enlarged peripheral nerves, usually near joints, such as the wrist, elbow and knees.”(Sehgal 24)
Nerves in the body can be affected causing numbess and muscle paralysis
Claw hand- the curling of the fingers and thumb caused by muscle paralysis
Blinking reflex lost due to leprosy’s affect on one’s facial nerves; loss of blinking reflex can eventually lead to dryness, ulceration, and blindness
“Bacilli entering the mucous lining of the nose can lead to internal damage and scarring that, in time, causes the nose to collapse.”(Sehgal 27)
“Muscles get weaker, resulting in signs such as foot drop (the toe drags when the foot is lifted to take a step)”(Sehgal 27)

Long-term Effects
“If left untreated, leprosy can cause deformity, crippling, and blindness. Because the bacteria attack nerve ending, the terminal body parts (hands and feet) lose all sensations and cannot feel heat, touch, or pain, and can be easily injured…. Left unattended, these wounds can then get further infected and cause tissue damage.” (Sehgal 27)
As a result to the tissue damage, “fingers and toes can become shortened, as the cartilage is absorbed into the body…Contrary to popular belief, the disease does not cause body parts to ‘fall off’.” (Sehgal 27)

Every year, Dr. Jun Xu and his team bring around $300,000 worth of medicine donated from his team members and Americares in Stamford, CT to treat the leprosy and other patients in Senegal and Guinea Bissau. http://www.americares.org/, in 2017, his team also received medicine donation from Direct Relief in California, https://www.directrelief.org/.
Dr. Jun Xu and his team finally established a clinic in the leprosy village, one building for the clinic, and another building for the living of doctors and nurses.

Leprosy village people were celebrating the opening of the clinic.

There are 8 wards, which could hospitalize the patients if it is medically necessary.

Dr. Jun Xu’s team usually stay in Senegal for 10 to 14 days, these are the foods his team brought from US in order to keep them health and safe. They do not dare to eat street food.

The above are the coolants contained food Dr. Jun Xu’s team brought from US

Dr. Jun Xu and his team from US in 2006.
If you are interested in joining Dr. Jun Xu’s team or donating to his work in Senegal, please address your check payable to AGWV, and send to
Jun Xu, MD, 1171 E Putnam Avenue, Riverside, CT 06878, USA.
Dr. Xu promises that all your donation 100% will go to Senegal and his team will nerve use a penny from your donation. You will receive the tax deductible receipt. Any amount is a great help for Africa patients.
For more info, please visit our websites at
http://www.drxuacupuncture.co/ and http://www.africacriesout.org/

14: Acupuncture and Trigeminal Neuralgia

Feb 25, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  2 Comments

Dear Patients and Friends:

February 14 was the first day of the Chinese New Year. This year is the year of the tiger. In Chinese tradition, the year of the tiger will usually make you look forward to the bright future and bring you an exciting fortune. Therefore, we wish you a Happy Chinese New Year of Tiger!

This month’s case discussion is about Trigeminal Neuralgia, which is common to middle and elderly aged people. We hope you may learn something from this case discussion.

Happy Chinese New Year!!!

Jun Xu, M.D. and Hong Su, C.M.D.


News Letter, Vol. 2 (2), February, 2010, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

www.rmac.yourmd.com; www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

TRIGEMINAL NEURALGIA

Sharon, a 65-year-old woman who suffered from a toothache on the right side of her mouth for a month, finally consulted her dentist who found two loose teeth in the back, right side of the mouth.  The patient loves sweets, which may have caused the problem, but the pain was so severe that she was unable to sleep.  The pain occurred proximally and started when Sharon tried to brush his teeth; the pain was so severe that she could not bear to touch the teeth or the right side of her face and jaw.  Even air currents could trigger the pain.  She had difficulty eating, talking, and brushing her teeth.  The shooting pain felt like electrical shocks and burning, and, at times, was unbearable.   It attacked the right side of the jaw and face and lasted for hours.  The patient intentionally tried not to use the right side of  teeth in order to avoid triggering an episode of pain.   Finally, the dentist decided to pull out the two lower teeth.  At this point, the patient felt immediate swelling on the right side of her face and, after a week, the pain became worse.  The doctor also prescribed narcotics to ease the pain. There was no improvement after the tooth extraction and the patient still could not touch the right side of his face.

Upon examining him, I discovered that although the pain did not extend to the right side of her eye, the right cheek and jaw were tender and the pain was described as intolerable by the patient.  She felt it was incapacitating her to the extent that she was losing normal function and had dropped ten pounds.  She also experienced fatigue and was unable to sleep.

Sharon is suffering from trigeminal neuralgia.  The trigeminal nerve carries sensation from the face to the brain.  Many studies indicate that when the superior cerebellar artery compresses this nerve, the nerves protecting the myelin sheath are injured, causing erratic and hyperactive function of the nerve.  This can lead to pain at the slightest stimulation of any area served by the nerve, as well hindering of the nerve’s ability to shut down pain signals when the stimulation ends.  The trigeminal nerve is the fifth cranial nerve, which registers sensory data such as pressure and temperature and measures pain originating from the face above the jaw line.  The trigeminal nerve has three branches, one going to the eye, the second to the mouth, and the third to the jaw.  In Sharon’s case, two of these three trigeminal branches (mouth and jaw) were affected. This condition is usually found in males and females at the ratio of 2:3, and most trigeminal neuralgia cases are idiopathic and typically occur in the sixth decade of life, although they may occur at any age.  The symptomatic or secondary trigeminal neuralgia may occur in younger patients.

The patient’s history is the most important factor in the diagnosis of trigeminal nerve neuralgia.   The nature of the pain may be brief and proximal, but it may also occur in multiple attacks and may be stabbing or shock-like or extremely severe.  It is usually distributed in one or more branches of the trigeminal nerve and is usually maxillary or mandibular and unilateral.  This pain typically lasts from a few seconds to one to two minutes and will typically occur for a few months each year.

Treatment with Western Medicine:

  1. Medications. The most typical medications prescribed by doctors and dentists are anticonvulsants such as carbamazepine, oxcababazepine, phyntoin or gabapentin.  Generally, these are the most effective for pain relief, and can be adjuncted with muscle relaxants such as baclofen.  Some opiates can also be effective such as OxyContin or Duragesic in patch form, for decreasing pain in the jaw and face, as well as low doses of antidepressants such as amitriptyline.
  2. Surgery. Surgery may relieve pressure on the nerve or selectively truncate the nerve by disrupting the pain signals from getting through to the brain. It is usually 90% successful if done by an experienced surgeon.  The most specific kind of surgery is microvascular decompression.
  3. Stereotactic radiation therapy. A surgeon uses a gamma knife or linear accelerator (a form of radiation therapy) such as the Novalis Cyberknife.  The therapy penetrates the skin and targets the selective nerve root and disrupts the pain signal transmissions.

Treatment with Traditional Chinese Medicine:

According to Traditional Chinese Medicine, the stomach meridian is distributed around the eye, the jaw, and the teeth.  Therefore, if the stomach meridian is blocked, the external wind and heat will be mutually mixed, and the wind flame will invade the stomach meridian and cause severe pain along the meridian (i.e. along the face, teeth, and eye).

The main treatment for trigeminal neuralgia is to soothe the stomach meridian by redistributing the wind, dissipating the heat and improving the energy flow in the area. The acupuncture points along the face, eye, and teeth must be carefully selected.  The three branches of the meridian should be treated separately:

1.       Ophthalmic nerve branch. This is the top branch of the trigeminal nerve.  Acupuncture points include the EX-HN4 Yu Yao, GB 1 Tong Zi Liao, SJ 23 Si Zu Kong, EX-HN5 Tai Yang and UB1 Jing Ming.  The needles should be inserted in 0.3 to 0.5 inches deep.  The patient should feel a stimulation similar to an electric shock. Continue to twist the needles three to five times, and then put the needles on the electrical stimulating machine for 30 minutes.

2.       Maxillary nerve branch. Use the St 2 Si Bai and St 1 Chen Qi points and the manipulation described above.

3.       Mandibular nerve branch. Use the St 7 Xia Guan, Ren24 Cheng Jiang and St 4 Di Chang points and the manipulation described above.

In addition, choose some body points such as GB40 Qiu Xu, Li v 5 Li Gou, LI 4 He Gu, Lu 7 Lie Que, etc. in order to adjust the energy of the entire body.

Stimulating these above acupuncture points can improve the energy flow and decrease the pain sensation signals that the trigeminal nerve sends to the brain.  The acupuncturist must ensure that the patient feels an electrical shock sensation from the needles.  This treatment allows the energy to go to the trigeminal nerve to improve the energy flow and decrease the pain.

Sharon was treated with a combination of Treatments # 2 and # 3 plus electrical stimulation of the acupuncture needles three times a week for three weeks.  After the first visit, she felt better and reported getting a good night’s sleep for the first time in six weeks.  After four weeks of treatment, the pain had subsided by 80%; thus, the treatments were decreased to once a month; after six months on this schedule, the patient told me he felt no more pain.

In my experience, the treatment of this illness has two facets.  First, there must be a clear diagnosis.  In Sharon’s case, the dentist was wrong in the evaluation of the condition, and pulled two teeth unnecessarily. It is also necessary to combine western medicine with TCM in this case, and to treat all three of the nerve branches, if necessary.  If the treatment is done properly, the patient’s pain should subside and he/she should be able to function normally in day-to-day life.

Tips for acupuncturists:

  1. You should combine the local points with the distal points for your treatment.
  2. Electrical stimulation is very important.
  3. Do not use moza in these kinds of cases.

Tips for patients:

  1. Seek for medical attention as early as possible.
  2. An ice-cold massage at the above points might decrease the pain.

 

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