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Tic Douloureaux: Applied Osteopathy for a Case of Refractory Trigeminal Neuralgia

Journal: The AAO Journal Date: 2025/06, 35(2):Pages: 9-10. doi: Subito , type of study: case report


Keywords:

case report [705]
male [763]
OMT [3746]
osteopathic manipulative treatment [3766]
trigeminal neuralgia [9]

Abstract:

Introduction/Background: Trigeminal neuralgia (TN) is a rare condition with an estimated prevalence of <0.1% in the general population. Mainstay treatment currently focuses on pharmacotherapy with anti-seizure agents and/or muscle relaxants, with surgical intervention selectively chosen for refractory cases. Literature regarding the management of TN with Osteopathic Manipulative Treatment (OMT), is sparse with only a handful of case studies describing OMT for TN. Case: A 43 year-old man presented with 15 years of frequent right posterior scalp pain radiating into the right eye and cheek. Associated symptoms included dizziness, nausea, photophobia, right eye pressure, blurred vision, scleral injection, and right-sided ptosis. He had failed many medications and underwent endoscopic sinus surgery without relief. His exam was notable for markedly diminished motion of the right hemi-cranium, an internally rotated right temporal bone, and chronic tissue texture changes at the right C4-C5 and C6-C7 levels. The patient was treated using myofascial release, strain-counterstrain, facilitated positional release, and osteopathy in the cranial field. Results: The amplitude of craniosacral movement improved considerably and there was restoration of the rotational motion of the right temporal bone. Following treatment, the patient was able to palpate his right face without discomfort. Upon follow up, the patient reported a period of relief regarding skin sensitivity and pain intensity. Treatment is ongoing. Discussion: This patient failed numerous costly mainstay treatments for TN. Treatment of a temporal bone dysfunction with OMT brought a period of symptomatic relief. This case study suggests that OMT can be a quick and effective means for managing symptoms of TN and calls for more research regarding the applications of OMT in the treatment of TN.


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