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New Insights Into Trigeminal Neuralgia

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Researchers in Denmark are providing new insights into the painful condition known as trigeminal neuralgia (TN).

Have you ever had a stabbing pain on one side of your face – almost like an electric shock? Maybe it just happens, or maybe it seems to come when you’re brushing your teeth, or even putting on makeup.

Trigeminal neuralgia is not a common disease, and so it hasn’t been studied nearly as much as many other pain disorders. But this study of 158 patients gives us a clearer picture.

  1. TN seems to strike later in life than conditions like migraine. The average age when symptoms appeared was about 53 years.
  2. Although both men and women get TN, it is somewhat more likely to affect women.
  3. Almost 50% of patients had persistent pain in addition to the stabbing pain. Sometime TN with persistent pain has been called “atypical”, but it doesn’t seem to be as atypical as some think (the more proper name, by the way, is classical trigeminal neuralgia with concomitant persistent facial pain. Has a ring to it, wouldn’t you say?).
  4. The pain is more often on the right side.
  5. A little less than a third had “autonomic symptoms”, such as dizziness, and a little less than a third had “sensory abnormalities”, even if they hadn’t had surgery.

Researchers also investigated the nerve that TN affects. TN can affect different branches of the trigeminal nerve in the face. They discovered that the first branch alone was rarely the problem. Usually the culprits were the second and/or third branches.

TN is usually treated with medications such as anticonvulsants and muscle relaxants. Botox has also been used successfully for TN, and in much smaller doses than are used for migraine.

In rare cases, surgery is recommended. However, surgery is not always a guarantee that the pain is gone for good.

A clinical trial is beginning in the USA also, in Philadelphia, to investigate the use of Botox for TN. If you would like to be a part of the study, you can find more information by clicking the last link below.

For more information:

Do You *Hear Voices* during a Migraine Attack?

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It’s rare, but it is occasionally reported in medical literature. Hearing auditory hallucinations, most often “hearing voices”, associated with a migraine attack.

Visual hallucinations are actually much more common, and can be something simple (such as seeing a flashing light) to something very complex (seeing people). But hearing things is so rare that it’s not usually considered a symptom or trigger of migraine.Hearing things during a Migraine Attack?

Researchers in the USA decided to do a little more research into this phenomenon. They confirmed that of all types of auditory hallucinations, hearing voices was the most common (but still only 58%). But the question remains, is this actually a symptom of migraine?

Most often the patients had the auditory hallucinations during the headache phase of the attack (75%), and it usually lasted less than an hour (67%). This seems to be something more common in patients who had at some time been diagnosed with depression, although many of the patients wouldn’t fit in that category.

In fact, it was difficult to say why these patients experienced this symptom, when the vast majority do not. We do know that in the case of these patients (12 of them – remember, this is very rare), the symptoms did always come with the migraine attack and disappeared afterwards.

So here definitions become important. Is this a migraine aura? A migraine symptom? Or could it be that auditory hallucinations are something caused by another factor, but triggered in some way by the migraine attack?

We do know that there are other physical problems that could lead to hallucinations such as hearing voices, such as blood flow to the brain or issues with the messages sent through the nervous system. But for now, although some patients may need special treatment just for the hallucinations, the answer seems to be the usual – treat the migraine attacks, and these strange symptoms should disappear as well.

Have you experienced anything like this during a migraine attack? We would love to hear from you!

Study abstract: Auditory hallucinations associated with migraine: Case series and literature review.

What is Retinal Migraine?

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What exactly is retinal migraine? Do I have it, or could it be another disease?
What is Retinal Migraine
Over the past year, our article from 2009 about retinal migraine (5 Signs You have Retinal Migraine) has become the most popular article at Headache and Migraine News. But almost six years later, it’s time to revisit the discussion.

There is a lot of confusion over just what retinal migraine is, and that confusion is making it difficult to find proper treatment.

First, retinal migraine is a type of migraine with aura. There are various different types of migraine with aura, and different treatments are commonly used depending on which type you have.

There are various types of “aura”, some visual but some involving muscle weakness or difficulty speaking, for example. Retinal migraine used to be in a category by itself, but it is now categorized along with other aura types. In fact, more specifically, it is considered migraine with typical aura.

Symptoms of Retinal Migraine

Retinal migraine symptoms must be temporary, must involve vision, must be in one eye, must be repeated, and must NOT be associated with a disorder other than migraine.

Visual symptoms will vary. You might have an area of vision blocked out, or you may go blind in one eye. Or, there may be visual patterns and flashes.

Typically, the aura spreads gradually over a few minutes, and lasts an hour or less. Usually (but not necessarily) the aura will be followed by a headache.

The important thing to remember here is that retinal migraine is still something pretty specific. If your symptoms are in both eyes, for example, you do not have retinal migraine.

Important: It May Not Be Migraine

It is absolutely critical to have a doctor examine you if you think you may have retinal migraine. There could be other causes of these symptoms.

For example, loss of vision in one eye could be a sign of a stroke. It could be a sign of carotid artery disease, in which arteries supplying blood to the brain are blocked. Needless to say, this could be very serious.

Aura symptoms could also be a sign of traumatic brain injury. A brain tumour may also lead to similar symptoms.

Some people still think of “retinal migraine” as a common, benign disorder. But a careful examination and proper treatment (whether it’s retinal migraine or not) is critical.

The diagnostic criteria above is based on The International Classification of Headache Disorders, 3rd edition (beta version) (pdf)

Abdominal Migraine in Adults

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Abdominal pain – likely a nauseous feeling – recurring again and again.  It can be very hard to get a diagnosis, but it could be abdominal migraine.

Abdominal Migraine in Adults

Abdominal migraine in adults is not often recognized, even though the medical community has been talking about it for almost a hundred years.  Abdominal migraine is well recognized in children, all the more reason why it’s overlooked in adults.  And to be fair, it probably is a rare condition.

As with most types of migraine, abdominal migraine brings on recurring symptoms.  It usually lasts from a couple of hours to three days.

Unlike migraine headache, the pain in the abdomen isn’t one-sided.  It could be very severe, or just a dull ache.  During an attack, there is usually nausea and/or vomiting, or you may become pale and lose your appetite.

To be technically diagnosed with abdominal migraine, there should be no headache associated with the attack.  In other words, instead of headache you have abdominal pain.  However, it’s true that other types of migraine may include abdominal pain as well.

Other characteristics of migraine may be present, such as an aura before an attack.

Abdominal migraine usually starts in childhood and disappears in adulthood (or “changes” into other types of migraine).  But there have been cases of abdominal pain from migraine appearing in adolescence and early adulthood for the first time.

Diagnosis of Abdominal Migraine in Adults

If the above description sounds like you, you’ve taken the first step.  But your doctor will still want to run some tests and rule out other possibilities.

Be sure to tell your doctor how many attacks you’ve had, and what the symptoms were.  She’ll want to rule out various other conditions, such as gallstones, irritable bowel syndrome, infections, and even abdominal epilepsy, which can be quite similar.

A common feature of abdominal migraine in adults seems to be a family history of migraine.  If you know anyone in your family who may have had migraine, be sure to mention that.  Also, your doctor will want to know if you had migraine symptoms when you were younger, or possibly cyclic vomiting syndrome.

Treatment of Adult Abdominal Migraine

Because it is so rarely diagnosed, there’s no standard treatment.  However, there are some treatments which have been used successfully.

Triptans, a common migraine abortive, such as sumatriptan, may be tried.  Pizotifen (pizotyline, Sandomigran, Sanomigran), a serotonin antagonist, has been used for abdominal migraine in adults.  Other migraine treatments such as topiramate (Topamax), calcium channel blockers, beta blockers, and valproic acid (Depakote) may be tried, depending on the patient.  Antihistamines have also been used.

For more information:

TRPV4 and “Switching Off” Headache Pain

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Imagine an old-fashioned but complex machine, based on switches.  When you turn on switch A, for example, it supplies power to switches AA, AB, and AC.  If you want power to go through these switches, you must turn them on.  And so there is a complicated interaction of hundreds of switches.

Don’t worry, that’s about as complicated as this article is going to get.  If you grasp the idea of the interaction of switches, that’s enough to understand the analogy.

Switch off MIGRAINE!

So what would happen if a switch got stuck?  Well, if it were stuck in the “on” position, you wouldn’t be able to stop the power flow through that switch.  If it were stuck in the “off” position, neither that switch nor any down the line would ever get power.

This is an over-simplified way to understand the way that some messages are sent through the body.  Each cell, for example, relies on something called “ion channels”, proteins which allow a flow of information through the wall of the cell.  Imagine it as a switch.

But what would happen if the protein wasn’t properly “programmed”?  It might let too much information through, or not enough.  It could get “stuck”.

Migraine research is focusing more and more on specific types of ion channels.  Consider this statement from a 2011 article in BMC Medicine:

We could now be at a watershed moment in this respect, as the genetic loci associated with typical forms of migraine are being revealed.  The genetic discoveries are the latest step in the evolution of our understanding of migraine, which was initially considered a cerebrovascular condition, then a neuroinflammatory process and now primarily a neurogenic disorder.  Indeed, the genetic findings, which have revealed ion channels and transporter mutations as causative of migraine, are a powerful argument for the neurogenic basis of migraine.

Many common migraine medications affect ion channels, such as verapamil and topiramate (Topamax).

But researchers are continually looking to new frontiers.  And one of these is the investigation into TRPV4, (a nice name for Transient receptor potential cation channel subfamily V member 4).  We know that TRPV4 is related to the sending of pain messages in the body.  Might it be involved in headache pain?

One of the interesting discoveries that researchers made was the link between TRPV4 and sunburn.  When TRPV4 is blocked, so is the sunburn pain (see Could discovery lead to end of sunburn pain?).

Trigeminal pain, often manifesting in face pain or headache, also seems to be closely related to TRPV4 (see TRPV4 is necessary for trigeminal irritant pain and functions as a cellular formalin receptor.).

A study published last year in Cephalalgia specifically looked at headache, and found that TRPV4 working in the tissue around the central nervous system (meninges) could actually contribute to migraine pain.

Is it possible that the hot pain of many headache conditions could be stopped with the flick of the TRPV4 switch?

Of course, it’s not that easy in real life to find the right switch and turn off pain without causing other problems.  And TRPV4 is one of only 30 channels in only on category.

We do know that various factors, such as environment (for example being exposed to chemicals in the air) can turn switches like TRPV4 on and off.  In other words, we’re not talking about flipping a switch that was never meant to be switched.  It could, for example, be that certain factors, in people with migraine, are flipping switches too often.  Perhaps a certain medication could put it back to normal.

This is a huge area of research, but we’re already using medications that involve ion channel “switching”.  Better understanding the switches helps us better understand headache and pain disorders, and directs us to the most likely methods of treatment.

If you want to dive even deeper into this topic, check out:

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The articles on Headache and Migraine News are © 2004-2025 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.