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Pain Physiology

The Trigeminal Nerve

When we think of nerves going up to and down from the brain, everyone knows about the spinal column. But there are also twelve pairs of nerve bundles that exit the bottom of the skull directly that have nothing to do with the spinal column. These are called cranial nerves. 

Cranial nerves are involved with several different and independent functions. Smell, vision, taste, tongue movement, hearing and several other jobs are carried out by the cranial nerves.  The focus of this brief summary is cranial nerve number five, the trigeminal nerve.

Each of the two trigeminal nerves (one for the left side of the head, one for the right) has three distinct branches; β€˜tri-β€˜ three; β€˜-geminal;’ twins (like Gemini, the Twins.)

Each of these three branches on both sides of the head are involved with both touch/position information and more importantly, heat/pain information.

All three branches of the trigeminal nerve send information to the brain. The first branch of the trigeminal nerve sends information from the base of the nose and up across forehead. The second branch sends information from the middle of the face: from your top lip and out across your cheekbones. That second branch attaches all the way up at your temple. The third branch sends information from the lower part of your face. It covers your lower jaw. Because the trigeminal sends information about the muscles that control the jaw, it runs around the curve of the jaw. up across the cheekbones, to the temples. You can feel those muscles when you chew.

Each of these areas is highly complex. Problems and irritation in the jaw, teeth, sinuses, eyes, and ears can all be transmitted through the trigeminal nerve and perceived as pain. For people who are vulnerable to migraine disease, problems in any of these areas can trigger a migraine attack.

Stimuli from the trigeminal nerve are important to assess when addressing migraines and chronic pain. The processing of heat/pain information in the brain is complicated and varies between people because it is tempered by memory and emotion. That being said, the trigeminal nerve is processing everything from a fly landing on your cheek to a twinge in a cold-sensitive tooth. From sinuses itchy from hay fever to the shock of punch in the nose. 

Although vulnerability to migraine disease and other headaches has a large genetic component, addressing basic issues that may stimulate the trigeminal nerve can be helpful in minimizing triggers.

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