Trigeminal Neuralgia
Female, 65. She had severe paroxysmal facial pain for 1 month, which had already seriously disrupted sleep and daily life. The main complaint was repeated burning, electric-shock–like pain near the left nasal wing for one-month, frequent attacks, and worse episodes at night. One month earlier, without an obvious trigger, she developed stabbing, electric-shock sensations and burning pain beside the left nasal wing. Attacks were paroxysmal, lasting from a few seconds to more than ten seconds each time, occurring about 20–30 times per day. Eating, talking, and washing the face could easily trigger attacks. Night-time attacks were particularly frequent, leaving her unable to sleep through the night. She had taken oral analgesics that slightly reduced pain but caused significant drowsiness and fatigue, forcing her to stop. Symptoms gradually worsened and anxiety increased, so she sought treatment.
Past history included many years of hypertension with acceptable control. There was no known history of stroke or intracranial tumor, and no previous trigeminal nerve surgery. She denied severe heart or lung disease and denied drug allergy history. On examination, in the distribution of the second division of the trigeminal nerve (maxillary branch) near the left nasal wing, a localized swollen, exquisitely tender small nodule was palpated. Touching it immediately triggered classic electric-shock pain with radiation upward and downward. Multiple tender nodules were also palpated at the posterior neck and the tip of the left C1 transverse process. Neck–shoulder–upper back muscles were markedly tight and in spasm. The upper trapezius, splenius/upper cervical muscles, and levator scapulae showed cord-like myofascial trigger points and taut bands. A brief neurological screen did not show limb motor or sensory deficits.
No recent cranial MRI report was available. She stated that prior evaluation at another hospital did not reveal an obvious intracranial mass lesion, and secondary trigeminal neuralgia was largely excluded. The working diagnoses were: Western medicine—trigeminal neuralgia (predominantly maxillary division); TCM—head/face pain within the categories of “head wind” and “facial pain,” often related to hyperactive liver yang and obstruction of the collaterals by wind-cold, phlegm, and stasis; Mini Ren-SNAN Acupuncture findings—prominent myofascial trigger points at the cranio-cervical junction and marked tenderness/nodules at the tip of the C1 transverse process, plus a focal tender nodule around the maxillary-branch exit region as a perineural structural lesion, forming an abnormal high-tension chain from upper cervical segment → skull base → maxillary nerve pathway.
Treatment
Mini Ren-SNAN Acupuncture was performed using a sterile, single-use mini-blade needle (0.35 mm × 25 mm), with insertion depth not exceeding 10 mm. For the first treatment, the patient was placed prone. From the suboccipital lower nuchal line to the upper nuchal line, systematic palpation was performed; the key focus was releasing tight muscle bundles in the trapezius and splenius/upper cervical muscles and releasing tender nodules around the C1–C2 transverse-process tips. Shallow anti-nodule release was applied with the blade edge oriented along the longitudinal axis, avoiding transverse cutting to reduce risk of nerve irritation. The patient was then placed supine. The focus shifted to the left cheek/maxillary-branch exit region, especially the most pain-sensitive trigger-point nodule. A short-range shallow technique with tiny micro-release was used to open the nodule and reduce local mechanical compression on the nerve. Treatment was delivered 1–2 times per week, about 10 minutes each session.
After the first treatment, the number of night attacks decreased significantly. The pain changed from electric-shock severity to a brief needle-prick sensation, and she could sleep intermittently. After the third treatment, most severe attacks disappeared; only mild discomfort occurred with cold exposure or excessive chewing. After 4–5 treatments, she fully returned to normal daily life and no longer needed oral pain medication. At 6-month follow-up, trigeminal neuralgia did not recur.
Discussion
This case shows that trigeminal neuralgia is not always a “problem of the nerve alone.” In many patients, the real driver is a combination of upper-cervical myofascial trigger points and a focal tender nodule at the peripheral exit region—together forming a high-tension mechanical pathway that repeatedly irritates the nerve. Conventional medication aims to suppress abnormal discharges, but benefits may be limited and side effects can be unacceptable. Mini Ren-SNAN Acupuncture provides a dual structural strategy—“upper cervical release + peripheral exit-point release”—to rapidly reduce local high tension and abnormal mechanical stimulation, which in turn reduces attack frequency and intensity. For stubborn facial pain, it is worth rethinking the condition through the lens of “nodular pain syndrome + high-tension chains,” because once the tangible lesion is addressed, improvement can be swift and durable.
Suggestion
to the patients who are suffering from this issues: If you experience sudden, electric-shock–like facial pain near the nose or cheek that is triggered by eating, talking, touching the face, or washing—and especially if it worsens at night and disrupts sleep—don’t endure it in silence or rely only on medications that make you exhausted. Book an appointment to meet Dr. Guojian Huang to discuss your symptoms and whether Mini Ren-SNAN Acupuncture may be suitable for you. Appointment link: https://ankang.cliniko.com/bookings#service