Patient Profile
Female, 65 years old. One-month history of severe recurrent facial pain, seriously affecting sleep and daily life.
Main Complaint
Burning, electric-shock–like pain around the left side of the nose for 1 month, with frequent attacks, worse at night.
History of Present Illness
One month earlier, she developed sudden, electric-shock–like stabbing and burning pain around the left nasal wing. The pain lasted from a few seconds to more than 10 seconds per attack, with 20–30 attacks per day. Talking, eating, or washing her face often triggered the pain, which was especially frequent at night, making sleep almost impossible. Painkillers reduced the pain slightly but caused significant drowsiness and fatigue, so she stopped taking them. As attacks intensified and anxiety grew, she came to my clinic.
Relevant History
Long-standing hypertension, reasonably controlled. No history of stroke, intracranial tumour, or trigeminal nerve surgery.
Examination
In the distribution area of the second division of the trigeminal nerve (maxillary branch) near the left nasal wing, a small swollen, very tender nodule could be felt. Touching it triggered the typical electric-shock pain radiating up and down. At the back of the neck and over the left C1 transverse process, multiple tender nodules were found. Neck and upper back muscles were tight and in spasm, with clear trigger bands in the upper trapezius, splenius, and levator scapulae. Neurological exam of the limbs was normal.
Diagnosis
- Western medicine: Trigeminal neuralgia (predominantly maxillary branch).
- TCM: Head and facial pain in the category of “Tou feng” and “Mian tong,” often due to liver yang rising and wind–cold–phlegm–stasis obstructing the collaterals.
- SNAN perspective: Pronounced myofascial trigger points at the cranio-cervical junction and C1 transverse process, plus a focal tender nodule at the exit of the maxillary branch. This points to a structural “tension chain” from upper cervical spine to skull base to the maxillary nerve outlet.
Treatment – Mini Ren-SNAN Acupuncture
Mini Blade Needle, 0.35 mm × 25 mm, insertion depth ≤ 10 mm.
- Upper cervical region (prone):
From the lower to upper nuchal line, trigger nodules and tight bands in the upper trapezius and splenius were released. The region around C1–C2 transverse processes was treated carefully with longitudinal shallow needling along the muscle and fascial direction, avoiding horizontal cuts across the nerve. - Maxillary nerve outlet (supine):
In the left cheek near the outlet of the maxillary branch, the most sensitive tender nodules were located and treated with short, shallow cuts of the fascial nodule to reduce mechanical compression on the nerve.
One to two sessions per week, about 10 minutes each.
Results
After the first treatment, the number of nightly attacks dropped noticeably. Pain changed from electric-shock–like to brief, milder stabbing pain, and she could sleep intermittently. After the third treatment, most of the severe attacks had disappeared, leaving only mild discomfort when exposed to cold or chewing forcefully. After 4–5 treatments, daily life returned to normal, and she no longer needed pain medication. During six months of follow-up, there was no recurrence.
Clinical Insight
In this trigeminal neuralgia case, the key was not just “nerve hypersensitivity,” but a combination of upper cervical trigger points and a small nodule around the nerve outlet. Drug therapy suppresses nerve firing but often has side effects and limited long-term success. Mini Ren-SNAN Acupuncture intervenes structurally from two directions: releasing upper cervical tension and “unblocking” the exit region of the maxillary branch. This reduces mechanical stimulation and local tension, which in turn diminishes the frequency and intensity of painful attacks.