Clinical Features: A 57 year old female presented with right sided trigeminal neuralgia (TN) of two years duration. TN pain was helped by medication and exacerbated by exposure to cold. Secondary complaints included high blood pressure, hypothyroidism, diminished hearing in left ear, cervicalgia, bilateral shoulder pain, right shin numbness and allergies. Prescriptions include Gabapentin 900 mg 3xs/day (2700 total with 3600 being maximum prescribed), triamterene 37.5 mg 1x/day, synthroid 75 mg 1x/day and nasacort as needed. History included being knocked unconscious in a fall when ten years old, significant fall while skiing thirteen years prior and recent fall onto the sidewalk. Orthopedic and neurological examination demonstrated the right leg one inch short relative to the left leg, one inch bilateral cervical syndrome and positive modified Prill tests for atlas (C1), axis (C2) and C5. Cervical x-ray analysis determined listings of axis entire segment right and a posterior C5. Diminished disc space and minor degenerative arthritis noted at C5/6 consistent with cervical trauma (whiplash.
Intervention and Outcome: One week after specific adjustments to C5 and axis, TN pain diminished dramatically in frequency and intensity. After discussing the improvement with her neurologist, she started cutting back on her Gabapentin dosage. After eight weekly visits, the patient was completely off the medication and pain free. Additionally, she reduced her high blood pressure medication by fifty percent. After two years of monthly maintenance care, she is still pain free without medication, even after major dental work.
Conclusion: This case study demonstrates the effectiveness of cervical specific care as an alternative to medication or surgery for the control of pain associated with TN.
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