What is Trigeminal Neuralgia?
Trigeminal neuralgia is a painful neurological disorder that affects one or more divisions of the trigeminal nerve, which carries sensory information from the face and head [1].
Trigeminal neuralgia is characterized by sudden, usually unilateral, intense, short-lived stabbing pain along the trigeminal nerve [2]. Therefore, neuralgia can be pain on one side of the head or face, which may repeat throughout the day [3]. Neuralgia attacks can be triggered by subtle stimulation, such as brushing the face, shaving or eating [1]. Although the pain only lasts 1-2 minutes, neuralgia has a profound impact on the quality of life of patients and can increase depression and anxiety in these individuals.
Causes of Trigeminal Neuralgia
Trigeminal neuralgia is a type of neuropathic pain caused by damage to the nerve fiber that carries sensory information. For example sciatic pain and pudendal neuralgia are also types of neuropathic pain.
Despite this, the exact cause of trigeminal neuralgia is unclear.
One of the leading theories is that a blood vessel at the base of the head compresses the trigeminal nerve where it leaves the brainstem [1].
Other causes include traumatic compression of the nerve by neoplastic or vascular anomalies, infection, and intracranial tumours or conditions that impair nerve myelination, such as multiple sclerosis [4].
Can Exercise Help with Trigeminal Neuralgia?
Medication is often the primary treatment for trigeminal neuralgia, but research suggests that exercise could be a beneficial alternative or complementary approach. Indeed, current medical guidelines advise a “Multimodal Rehabilitation Approach,” which encompasses psychological therapy, physical activity, and physiotherapeutic exercises.
In humans, the following exercises have helped reduce aspects of pain, such as max intensity or pain duration [5]: aerobic training, aerobic and resistance training, high intensity interval training, massages and chiropractor interventions [6]
Preclinical studies, that is, studies done with mice or rats, showed that swimming could reduce neuropathic pain. Specifically, two weeks of daily exercise reduced mechanical allodynia – pain elicited by a non-painful stimulus, such as touch or brushing [7].
Therefore, there is scientific evidence that exercise can alleviate neuropathic pain, such as trigeminal neuralgia, and exercises for exercises for pudendal neuralgia may also be beneficial. But how does this work?
How Does Exercise Relieve Pain in Trigeminal Neuralgia?
The mechanism of how exercise relieves pain in trigeminal neuralgia is unclear. A preclinical study found that exercise improved markers of inflammation, which can reduce the inflammation response to nerve compression, thereby alleviating pain [7].
Another plausible theory is that the exercise physically ‘massages’ the nerve fibre. This phenomenon is similar to when you rub your knee after hitting it. In science, this is called Gate Control Theory, where the nerve fibres communicating touch would suppress the nerve fibres carrying pain, so activating touch nerve fibres would suppress your pain [8].
Specific Exercises to Relieve Trigeminal Neuralgia
Here are several science-backed exercises to reduce inflammation and massage your trigeminal nerve when you feel trigeminal pain is coming [7, 5, 9]:
- Aerobic activity such as swimming, brisk walking, cycling or Zumba
- Head Tilting: Tilting your head from side to side, holding the position for several seconds enables the trigeminal nerve to find space and avoid compression.
- Slowly rotating your head: The trigeminal nerve is found in the brainstem, where trigeminal pain originates. Massaging this section of the nerve can prevent pathological compression of the nerve.
- Massage your temples: Take small circular movements along the side of your face with your index finger. This is where there are many branches of the trigeminal nerve, so massaging can stimulate the trigeminal nerve and suppress pain.
- Breathing: Slow your breathing and focus on engaging your diaphragm. This sign of rest-and-digest mode can slow your sympathetic nervous system and reduce stress and inflammation, helping to quieten pain signalling from a compressed trigeminal nerve.
Other Treatments for Trigeminal Neurlagia
As well as exercise, the following drugs are commonly used to treat trigeminal neuralgia [10]:
- amytriptiline
- Tricyclic antidepressants
- Carbamazepine, a type of benzodiazepine
- Opioids, such as morphine
- Paracetamol
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- COX-2 inihibtors
Summary: Can Exercise Relieve Trigeminal Neuralgia?
Yes! Exercise can certainly relieve mild trigeminal neuralgia and is an excellent way to prevent subsequent trigeminal pain attacks. The suggested exercises are safe and, when done slowly, are hard to get wrong. However, trigeminal neuralgia is a severe neurological condition for which you should consult a neurologist or healthcare professional. If you feel that the pain is not getting better with exercise, they will need to prescribe medication to help your daily functioning.