TN and the Myth of Upper Cervical Care?

In 1997, author James Tomasi treated his trigeminal neuralgia with upper cervical chiropractic adjustment and was cured of his pain; he subsequently published the book "What Time Tuesday," detailing his experiences with TN, the pain that almost drove him to suicide, and the procedure that cured him.

According to the NUCCA (National Upper Cervical Chiropractic Association), upper cervical care procedures were developed more than forty years ago and, since that time, have gained popularity within the medical community. Generally, upper cervical corrections involve adjusting the large, first vertebrae of the spinal column, called the "atlas." When misaligned- either from everyday activities over time, or trauma to the neck- the atlas can compress the brainstem and cause pressure where previously there was none. The pain of a misaligned atlas can manifest itself in many different ways, and patients with everything from back pain to indigestion have experienced some positive results with upper cervical correction (UCC). Ideally, when a chiropractor corrects the atlas alignment, he (or she) helps straighten the spinal column and removes pressure on any nerves that the misaligned bone may be pressing.

The procedure seems to offer viability for TN patients because it deals with pressure at the base of the brain, near the brain stem, which is the region more invasive techniques- such as microvascular decompression- address (this is where the trigeminal nerve exits the brain). Yet, it is only recently that TN has been treated with UCC. Why? First, there have not been clinical trials that evaluate the connection between TN and upper cervical corrections, and there are no statistics to gauge the success rates of such procedures for TN patients. Second, there is a lot of political tension between the medical and chiropractic community. Seemingly floating between "alternative" treatments and medical procedures, the niche that chiropracticity has carved for itself is very self-contained; because of this, little advertisement is made for chiropractic treatments. Third, not many TN patients seem to have used UCC to treat their pain, so testimonials are few and far between (except, of course, Tomasi's book). Because of all these reasons, it seems difficult to even offer an opinion as to whether the upper cervical correction is worthwhile. Personally, I would tend to avoid such techniques, but I fully recognize that much of that tendency is simply a result of the doctor-vs.-chiropractor bias. There are many cases in which chiropractors are the only viable option (a misaligned spine, for example), but for many people (myself included), the breadth of symptoms that chiropractors can cure makes it seem more "holistic" and less precise.

But that is not fair to the chiropractic field. The spinal column is a central part of the human anatomy, and its involvement with so many physiological roles means that its negative effects can manifest themselves in many places and many ways. Those who have experienced chiropractic treatment- specifically, UCC- can testify that the process is very thorough, with little guesswork involved (assuming the chiropractor is qualified and by-the-book). There are a number of different techniques to re-align the atlas (which can vary from chiropractor to chiropractor), but many involve the use of a "percussion adjusting instrument" which applies a precise, split-second sound vibration to one end of the atlas (just below the ear). This generates a slight pressure (about 3 lbs) that causes the vibration to move through the atlas to realign it. The instrument itself resembles some kind of power tool- an electric drill, perhaps- but the procedure is painless; the patient only feels a slight pressure like a brief tap or massage. The "stylus" on the instrument (the rod that applies the pressure) can be aimed to a particular degree, based off x-rays taken before the procedure.

There are a lot of positive aspects to UCC: it is painless, eases symptoms almost immediately, and there are few side effects. Although the procedure does not involve any cutting or other invasive techniques, however, it is important that your chiropractor be meticulous and well-qualified. The spinal column, for all its strength, is a delicate instrument, and further damage can create even more drastic problems; for example, pressure to a nerve can increase pain, and pressure to a vessel can cut off blood flow, causing a stroke. The negative aspects of UCC- besides its side effects, which result primarily from negligent chiropractors- include the cost of the procedure over time. Ideally, one would only need to have their atlas corrected once (cost for this includes the cost of x-rays, but varies from chiropractor to chiropractor), but the treatment can also entail repeated visits if the patient continually misaligns his/her spine. Luckily, this can often be avoided with basic preventative measures, such as not falling asleep on the couch or with one's head at an awkward angle. Ultimately, in the search for relief from TN, UCC may be included in the list of possible treatments, particularly as a non-invasive alternative with few side effects. With the low risk, UCC may be a reasonable option to try before surgery.