Medical AcupunctureVol. 34, No. 3 Clinical PearlsFree AccessHow Do You Treat Trigeminal Neuralgia in Your Practice?Published Online:16 Jun 2022https://doi.org/10.1089/acu.2022.29207.cplAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail I am constantly amazed at how effective acupuncture is as a treatment for trigeminal neuralgia (TN), given that the neuralgic facial pain is extremely severe, sharp, and lancing in character. It is normally confined unilaterally to 1 or 2 divisions of the nerve and lasts from a few seconds to a few minutes at a time, but may be repeated in bouts for a short while after a stimulus—often minor—has set it off.Treatment is with potent drugs or invasive techniques, including surgery. The recommended first-line medication is the anticonvulsant carbamazepine, which, unfortunately, has a variety of side-effects, making it unsuitable for some patients. However, a systematic review of 12 randomized controlled trials of acupuncture for TN reported that “acupuncture is of similar efficacy as carbamazepine, but with fewer adverse effects.”1 Thus, I have found patients to be very grateful for the relief that acupuncture can provide.The fifth cranial nerve—the trigeminal nerve—is predominantly a sensory nerve. It has 3 divisions, which originate from the trigeminal ganglion on the base of the skull. I regard these divisions as the key to my selection of points for treatment of TN. Helpfully, a Chinese survey of 26 case reports, trials, and observational studies to determine common methods and acupuncture-point selection for TN found a consensus that there should be specific treatment points related to the nerve distribution for each of the divisions. Thus, similar groups of acupuncture points were reported by most investigators. LI 4 and LR 3, which I use as distant points, are ubiquitous.2Ophthalmic DivisionThe ophthalmic division exits the skull through the superior orbital fissure behind the eye and provides sensation to the forehead above the eye and the surface of the nose. Thus, I use points within this area: GB 14 and ST 8 on the forehead, and BL 2 or Yuyao over, respectively, the supratrochlear or supraorbital nerves above the eye. However, although the ophthalmic division is commonly affected in postherpetic facial neuralgia, it is rarely involved in TN except together with the other 2 divisions.Maxillary DivisionThe most commonly affected division is the maxillary division, either alone, in combination with the mandibular division, or, rarely, with both of the other divisions. The maxillary division emerges via the inferior orbital fissure, with its infraorbital branch traveling through the foramen rotundum to the infraorbital foramen, which is at the point ST 2. This nerve is sensory to the front of the face below the eye, and the upper anterior teeth. Another branch supplies the temporal area, with Taiyang well-placed to stimulate the temporal nerve. Thus, I use both of these points.Mandibular DivisionThe third division, the mandibular division, passes through the foramen ovale and supplies the side of the face beside the ear, the chin, and the lower jaw and teeth. This division also carries a motor supply to the muscles of mastication. There is a plethora of points on the Gall Bladder, Small Intestine, and Triple Energizer meridians, just anterior to the ear where the parotid gland is situated. Initially, using several needles, I had problems with bruising in this area, so I now use a single needle, tracked superficially between the 3 points: TE 21, SI 19, and GB 2.With care, I can thus avoid needling through the parotid or puncturing the deeper blood vessels. I have learned to insert caudally from TE 21 superiorly, as the weight of electroacupuncture (EA) leads can pull the needle out if inserted from below. Points of the Stomach meridian lie over the lower jaw. I select ST 6, at the angle of the jaw, as a point often recommended for neuralgia of the mandibular division.2Contralateral NeedlingTN usually exhibits allodynia and hyperalgesia. Thus, pain can be set off by stimuli that are not normally painful in themselves, or would be expected to induce minimal nociceptive activity. Common examples complained of are: wind (people dress with a scarf or hood); tooth-brushing (and they are reluctant to go to the dentist); chewing (a soft diet may be necessary); and even a light touch on the face. Thus, needling of acupuncture points within the affected area can act as a trigger to precipitate neuralgic pain.My practice, therefore, is to avoid the neuralgic area completely, needling the above selected points on the contralateral side only, with additional points on the ipsilateral side above and below the affected division(s) if possible (e.g., GB 14 and ST 8 if the ophthalmic area is not involved, and ST 6 if the mandibular division is spared). This acupuncture technique conforms with traditional teaching and was demonstrated to be effective for TN in a trial comparing the use of facial points on the affected side with the same points used contralaterally. Both methods produced improvement, but using the healthy, contralateral side gave greater benefit.3 Contralateral treatment also appears to be valid neurophysiologically because acupuncture stimulates release of the endogenous opioids, serotonin and norepinephrine, which should all have generalized effects via cerebrospinal fluid and the bloodstream.TreatmentMy first session of acupuncture is a gentle one, with few needles and little stimulation, in order to assess the response and avoid worsening the patient's neuralgic pain. Subsequently, I increase the stimulation during weekly treatments aiming to reach 20 minutes of EA at 2/100 Hz within 1 month. I warn patients to make no change to their medications even if there has been a rapid, good response to the acupuncture. This is because rapid reduction of some of the drugs can result in a rebound worsening of symptoms, and also because one of the commonly prescribed treatments, amitriptyline, is synergistic with acupuncture.4 Amitriptyline, the tricyclic antidepressant, is a reuptake inhibitor of serotonin and norepinephrine, which effectively slows their removal following the boost by acupuncture treatment. Thus, premature cessation would upset the balance.If there is a good response, benefit is often long-lasting with few if any flare-ups, unless drug treatment has been tailed off too rapidly, but I have noted that recurrence is likely if a patient has a major trauma, such as a death in the family or a motor accident. However, only a few treatments are needed to restore full benefit again. Finally, although TN usually occurs spontaneously, it could be associated with a tumor or multiple sclerosis, neither of which should be overlooked.Address correspondence to:Simon Hayhoe, MSc, MBBS, MRCA, DAPain Management DepartmentUniversity HospitalTurner RoadColchester CO4 5JLUnited KingdomE-mail:simonhayhoe@doctors.org.ukTrigeminal neuralgia (TN) is considered to be one of the most difficult pain conditions to manage. TN is commonly intractable to medications, as well as to surgery and radiation treatments. Various hypotheses on TN's causes exist with little consensus. Since the 1960s, the primary approach has been prescription of anticonvulsant medications, including carbamazepine.1 However, no noteworthy success rates have established any medical standard. Beyond pharmaceutical palliation, the focus has been neurovascular compression (on the superior cerebellar artery) sometimes evident at the trigeminal nucleus. Surgical microvascular decompression may be effective in some cases, with significant risks.Diagnostic imaging does not always reveal evidence of arterial encroachment of the trigeminal nerve. Furthermore, anatomical contact alone does not constitute proof of cause of the patient's TN. It is plausible that such findings could be present in people not suffering from TN, thus, being a potentially coincidental finding.I contend that vascular-based irritation is a less-common TN cause than has been hypothesized. Most patients I have encountered over 30 years reported TN onset subsequent to appropriate and competently administered dental treatment. This is hardly a criticism of dentists, but rather an indication that a neurologic trigger remote from the trigeminal nuclei can be causative. It is plausible that a trauma-triggering mechanism similar to that of complex regional pain syndrome exists. No identifiable nerve injury may be present; however, the consequential neurologic malfunction occurs without physical evidence.I have treated TN in patients successfully by focusing on the upper cervical (UC) spine—via the 3-Phase auricular acupuncture microsystem, as well as structural correction. My neuroanatomical basis is the convergence in the trigeminocervical nucleus between the trigeminal nerve and the first 3 cervical nerves. The UC spinal cord has sensory nerve fibers in the descending tract of the trigeminal nerve, which may interact with sensory fibers from the UC nerve roots.2–4 Evidence exists to warrant consideration of the UC spinal-cord stimulation for patients afflicted with TN.5 If a patient's TN is a manifestation of brainstem/upper cervical dysfunction, treatment attempts via dental extractions, rhizotomies, or brain surgery will not be effective. No large clinical trials have been conducted; however, considerable evidence exists supporting clinical consideration of the trigeminocervical component in all cases.6–17General stimulation of auricular branches of cranial nerves has been vastly described in nonacupuncture academic medical literature as neuromodulation or transcutaneous auricular nerve stimulation (typically vagus or trigeminal). Studies (too numerous to cite) reveal auricular stimulation to be scientifically validated and easily implemented brain-modulation techniques.18 3-Phase auricular acupuncture achieves the most specific targeting of these cranial nerves. Acupuncturists must scan with an electrical detector for points within projection zones of the trigeminal nerve, as well as those of the UC spine, in all of 3 Nogier phases. No generic trigeminal nerve points exist (as per point-based ear acupuncture nomenclature). Treatment will be different for each patient—determined by findings rather than a standard set of points (Fig. 1)FIG. 1. Trigeminal neuralgia auricular therapy. © Donald K. Liebell, DC, BCAO, 2022.For example, a patient initially receives treatment twice per week for 4 weeks. Points detected within auricular zones (of all relevant structures) are treated with electrical stimulation for 30–60 seconds at frequencies appropriate for each zone (Fig. 1). An instrument capable of providing the full spectrum of Nogier frequencies (2.5, 5, 10, 20, 40, 80, or 160 Hz) is necessary. In the absence of such an instrument, needling is required. In some cases, semipermanent, size #3 SEIRIN® Spinex™ intradermal needles (Lhasa OMS, Weymouth, MA, USA) are inserted and covered with protective tape. Adherence is fortified by applying Mastisol® medical liquid adhesive (Eloquest® Healthcare, Detroit, MI, USA). This enables ongoing stimulation for days to several weeks. In addition to treating points correlating with the UC spine and trigeminal nerve, projection zones for brain structures associated with general pain modulation should be addressed. These include the frontal cortex, cerebellum, prefrontal cortex, cingulate gyrus, basal ganglia, and amygdala.19In addition to 3-Phase auricular therapy, it is advisable for practitioners to recommend UC chiropractic specific correction, especially patients who have not obtained relief through medications, radiation, and/or surgical interventions. Direct physical treatment by a qualified specialist in the UC spine would be provided, based upon misalignment determined by mathematical X-ray analysis. Neck exercises are contraindicated. In the absence of access to an UC specialist doctor, all efforts via acupuncture should be focused on the UC spine, cranial nerves, and pain modulation.Further supportive is application of low-level laser therapy (LLLT). A review showed that laser therapy facilitated significant reduction in intensity and frequency of TN pain in comparison to other strategies devoid of side-effects.20 Clinical studies of LLLT's effects on injured nerves have revealed an increase in nerve function.21 There is no consensus on specific frequencies or other laser parameters. I administer laser therapy (3LT® Erchonia Medical Corp. Melbourne, FL, USA) for 3 minutes, twice per week for 4–8 weeks (< 5 mV; 635-nm wavelength) to the head, neck, and face at 61 Hz to the nerve, 4 Hz to the brainstem, 9 Hz to the area of involvement, and 36 Hz to the spinal cord. I have observed these aforementioned frequencies to be beneficial through more than 15 years of clinical laser experience. While not all cases respond with improvement, natural support for TN has been consistently effective, using this combination of auricular therapy, UC correction, and laser therapy. Results have varied from temporary relief to complete resolution.Address correspondence to:Donald K. Liebell, DC, BCAOThe Liebell Clinic—Chronic Pain & Wellness Solutions477 Viking DriveVirginia Beach, VA 23452USAE-mail:necksecret@gmail.comTrigeminal neuralgia (TN) is the most-common form of neuralgia and is the result of inflammation or compression of the trigeminal nerve, which runs along the side of the face. TN is typical, chronic, peripheral neuropathic pain, according to the International Association for the Study of Pain (IASP).1 TN is often associated with marked emotional changes, especially depression, and disability in performing activities of daily life.Therapeutic management for TN is challenging. Medications recommended as first-line treatments provide less-than-satisfactory relief for many patients.2 The range of treatments available for pain directly caused by diseases of the nervous system includes pharmacologic, physical, interventional (nerve blocks, etc.), and psychologic therapies. Treatments for pain are used in association with other forms of treatment for the primary condition, unless, of course, pain itself is the primary disorder.3 Similar to other chronic-pain conditions, only a small proportion of trial participants experience a good response to treatment for neuropathic pain.4Acupuncture has been increasingly used to treat chronic pain, including neuropathic pain, and is one of the most-popular types of complementary and alternative therapies available in Western health care.5 TN is one of the most-commonly studied chronic neuropathic pain conditions treated with acupuncture.6With the development of the acupuncture brain theory, it is believed that TN is caused by head and or brain collaterals Stagnation or Wind in the Brain. Scalp acupuncture (SA) is a new form of acupuncture technique that is based on Chinese acupuncture theory and needling technique with a combination of neurologic knowledge. SA stimulates the areas of the certain zones on the head that correspond to the underlying brain-function zones. SA is most used for neurologic and mental disorders.7 SA plus general acupuncture for many neurologic diseases, such as trigeminal neuralgia (TN), induces better results than body acupuncture only. Commonly used SA areas for TN are Foot Motor Sensory Area, Sensory Area, Emotion Area.A Typical CaseM. was a 68-year-old, retired, former post office worker, suffering with TN for the past 3 years. He had visited many neurologists and pain clinics, and tried many types of painkillers, even strong ones including carbamazepine and gabapentin. Unfortunately, neither one worked for him successfully. His trigger point was located inside his upper jaw. This pain was triggered easily by food, water, and even cold air. He could not eat properly, nor could he sleep well. The pain was impacting his daily life severely, and was very stressful. In the last several weeks before seeing me, his symptoms had gotten worse.TN was my diagnosis after routine consultation and physical examination with M. My treatment was SA on both sides of the Foot Motor Sensory Area, the low Sensory Area, and the Emotion Area, plus same-side needling on ST 6 (Xiaguan) and ST 4 (Dicang), both LI 4 (Hegu), and Ren 12 (Zhongwan). Needle retention was 20 minutes, and treatments were twice per week.After the first treatment, M. reported a reduction in symptoms of ∼50%, and he had a very relaxed sleep, which was the best sleep he had had in the last year. With continued treatments, he improved in a stable fashion and, finally, his TN pain was completely gone after 15 sessions. After a 6-month break from treatments, he had a little relapse and asked for another 2 treatments until the pain was gone again. At a 3-year follow up, he was still pain-free.ConclusionTN is a very challenging disease that does not respond satisfactorily to general medical care and even general acupuncture treatment. SA may play an important role in the management of TN. The commonly used areas are Foot Motor Sensory Area, Sensory Area, and Emotion Area.Address correspondence to:Tianjun Wang, PhDLondon Academy of Chinese Acupuncture1 Harley StreetLondon W1G 9QDUnited KingdomE-mail:info@tjacupuncture.co.ukIn Vietnamese Imperial Medicine, trigeminal neuralgia (TN) can be summarized as Yin Fire Deficiency/Yang Water Deficiency. I have treated this pathology successfully with acupuncture, moxibustion, and pharmacopuncture, following the Tree of Life diagnosis as follows:First: Identify which Basic Component is affectedI ask the following questions to learn which Component needs to be treated: Are you more than 21 years old? (Jing): Treat with acupuncture and moxibustion to KI 3 and Ren 4.Do you get tired? (Qi): Treat with acupuncture and moxibustion to ST 36 and Ren 6Do you sleep poorly? (Shen): Treat with acupuncture and moxibustion to HT 7. Treat with acupuncture to Du 20.Do you have cramps or are you thirsty (Xue/Jin Ye)? Treat with acupuncture and moxibustion to BL 20 and BL 21.In all cases, I use superficial needling and ambiguous manipulation until De Qi is obtained. A quick way to treat the Three Treasures is to apply acupuncture and moxibustion to Ren 4, Ren 6, and Ren 7. This is an ancient recipe to tonify the Basic Components: Jing, Qi, and Shen, respectively.1Second: Identify the site where the problem isI palpate the Mu points. The reactive points indicate the affected meridian. If there are no reactive Mu points, I will work on the meridians where the pain is projected, in the same way.A note on puncturing and Yin and Yang functions is in order here. The Yin meridians have their Yang functions in the points on the left and the Yin functions on the right. The Yang meridians have the Yang functions on the right and the Yin functions on the left. I tonify clockwise and disperse counterclockwise in the meridians, going from the thorax to the hand and from the head to the foot. I tonify counterclockwise and disperse clockwise in the meridians going from the hand to the head and from the foot to the thorax,Third: Identify the affected functionFinally, I palpate the pulse and count its frequency in 1 minute. If the pulse is faster than 85 beats per minute (bpm) and superficial, I tonify the Yin Fire function. If it is ∼60 bpm and deep, I tonify the Yang Water function. Only one function is affected.Fourth: PharmacopunctureI inject 0.1–0.3 cc of vitamins B1–B6–B12 in Ah Shi points on the face and other acupuncture points related to the affected branch of the trigeminal nerve.Illustrative CaseFirst: Identify which Basic Component is affectedThe patient, was a 36-years-old female (Jing) with a family history of TN. She came to the clinic with recurring pain crises that were refractory to treatment with conventional medication. She reported that the pain hurt mostly when she was chewing, so she avoided eating. She had lost weight and slept poorly (Shen).Second: Identify the site where the problem isShe had reactive Mu: I used Ren 12 (Stomach). LU 1 (Lung), GB 25 (Kidney), and Ren 5 (San Jiao).Third: Identify the affected functionI palpated her pulse to determine whether to treat Fire Yin or Water Yang. There were two possible situations.For, situation 1 (Fire Yin Deficiency) with a superficial pulse of 92 bpm, I would treat Jing and Shen. Additionally, I would treat Fire Yin points as follows:ST 41 left and LU 9 right; as they are on centrifugal meridians, I would tonify clockwise.KI 2 right, San Jiao 6 left; as they are on centripetal meridians, I would tonify counterclockwise.For situation 2 (Water Yang Deficiency) with a deep pulse of 60 bpm, I would treat Jing, and Shen. Additionally, I would treat Water Yang points as follows:ST 44 right and LU 5 left; as they are on centrifugal meridians, I would tonify clockwise.KI 10 left and San Jiao 2 right; as they are on centripetal meridians, I would tonify counterclockwise.The puncturing, in all cases, would be superficial, trying not to pass through the skin with the smallest and thinnest needles possible. It was important that the puncture would not be not painful.Fourth: Pharmacopuncture:I identified the Ah Shi points and points related to the patient's painful area. In this case, she had pain when chewing. Thus, I injected the vitamins into ST 2, ST3, ST 4, ST 6, ST 7, etc. at the level of her facial musculature.ConclusionsIt is important to personalize the treatment to the needs of each patient at each time he or she comes for a consultation. Each time the patient comes, I will diagnose the basic components, systems, and functions. For 1 diagnosis, there will be 1 treatment. This treatment can be once or twice per week. Relief should be seen from the first time.Address correspondence to:Felipe Abreu Márquez, MDUrbanización Entre RíosCalle Sexta Manzana L1 Solar 14Parroquia la Puntilla SamborondónProvince of Guayas 092301EcuadorE-mail:hoathienecuador@gmail.comTrigeminal neuralgia (TN) is a form of neuropathic pain that affects the trigeminal nerve.1 The etiology and underlying pathophysiology of TN remains unknown in Western medicine. Traditional Chinese Medicine (TCM) states that TN belongs to the categories of migraine, face pain, and Cold–Wind invasion of the Head. Zhang Lu, the renowned TCM master in the early Qing Dynasty, wrote in his treatise Zhang's Medical Communication2: “Facial pain…can't open mouth to speak, and hurts when touched by hands. This is because the Yangming meridian is affected by Wind poison, which is passed on to the meridian, and the Blood Stagnates and doesn't circulate.” On the theory of pain in TCM, Li Zhongzi, a renowned TCM doctor in the Ming Dynasty, wrote in his book Required Reading for Doctors3: “No free flow, pain. Free flow, no pain.”TN pain is located on the face and is directly related to the three Yang meridians of the Hand and Foot in the TCM theory on meridians. The etiology and pathogenesis in TCM are that the Qi and Blood are blocked in the facial meridians due to exogenous pathogenic Qi, internal emotional injury, and prolonged illness. Therefore, TCM advocates that the principle of treatment is to promote the circulation of Qi and Blood, and dredge the meridians in order to relieve the pain. Acupuncture can effectively stimulate the blocked nerves, dispel Wind, clear Heat, and relieve pain through the use of acupoints such as ST 8 (Touwei), GB 14 (Yangbai), SJ 23 (Sizhukong), Ex-HN 5 (Taiyang), GB 3 (Shangguan), SI 18 (Quanliao), ST 7 (Xiaguan), and ST 6 (Jiache). The selected acupoints cover the 3 major branches of the trigeminal nerve—(1) the ophthalmic nerve (V1), (2) the maxillary nerve (V2), and (3) the mandibular nerve (V3)—through the application of acupoint-to-acupoint penetrative needling (AAPN) together with an electroacupuncture (EA) device. In this way, the purpose of treatment is achieved.4CaseDominique, age 43, presented on January 18, 2022. She had had pain for 5 years on the left side of her face. Her symptoms included severe pain in her left cheek, pain focused in the mandible area and radiating to the temple. She was unable to sleep every night, and woke up often due to the sharp stabbing pain. The pain was aggravated when she opened her mouth. She could only open her mouth less than 1-finger width./or a light breeze on her face. Her appetite was low and her energy was weak. Her stools were dry and hard, she was irritable, her tongue was red with a greasy coating, and her pulse was rapid and taut.Inspection of the level of pain in the affected muscles included the anterior neck tendon, left trapezius, sternocleidomastoid, and scalene muscles. The scale of pain was 8/10 based on a numerical rating scale.TCM diagnosis and differentiationThis patient had trigeminal neuralgia facial pain due to Wind–Phlegm blocking the meridians and collaterals and Liver Qi Stagnation.Strategy for EAThe treatment aim was to promote circulation of Qi and Blood, and to dredge and unblock the meridians and collaterals, and, thus, relieve Dominique's pain.Treatment methods Treatment was with an acupuncture electric stimulator (model KWD-808I, brand Greatwall). The needles were 0.30 × 60 mm. AAPN4 was applied on the affected side of her face to a depth of 30–40 mm. The selected 4 pairs of acupoints were ST 8 to GB 14, SJ 23 to Ex-HN 5, GB 3 to SI 18, ST 7 to ST 6.After disinfecting all points with a cotton ball dipped in alcohol, 4 needles were inserted at 30° to the skin, and were rotated 1 way until the muscle fibers wrapped the needles. After provoking De-Qi sensations, the EA device was connected to the t4 needles and set to a continuous wave at 1 Hz. The duration was 30 minutes for each session, and a TDP [Te-ding Dian-ci-bo Pu, a pinyin abbreviation for Particular Electromagnetic Spectrum] lamp was used on her face. The frequency was twice per week for 4 consecutive weeks.ResultsAfter 2 treatments, this patient's level of pain decreased by 50%; after 4 treatments, she could open her mouth to a width of 2 fingers. Her pain was mild. After 6 treatments, the pain was gone and her overall health was improved (she had better energy, was in a good mood, had deeper sleep, and had a normal appetite). After 8 treatments, function of her trigeminal nerve had been restored.Address correspondence to:Xiangping Peng, LAc, PhD, MSc1538 Sherbrooke West, Suite 210Montreal QC, H3G 1L5CanadaE-mail:acuenergie@gmail.comTrigeminal neuralgia (TN) is a painful condition that is associated with unilateral, lancinating, and sudden pain attacks in the distribution of the trigeminal-nerve branches. The attacks last from a few seconds up to 2 minutes and are often associated with typical triggers, such as talking, eating, brushing teeth, or cold wind exposure. There is generally no pain between attacks.1 Classical TN is associated with compression of the trigeminal nerve by a blood vessel. Secondary TN is attributable to compression by a tumor or to demyelination of the nerve.2 Patients with TN commonly experience electric shock–like sharp pain. The treatment usually includes medications, such as anticonvulsants, as an initial approach or surgery.3 Although these approaches are effective, there are limitations in pharmacologic or surgical therapies for managing TN.Traditional Chinese Medicine (TCM) explains TN usually as an invasion of Wind–Cold pathogens in the face, leading to nerve inflammation and Stasis. TN may also arise from excessive Fire of the Liver and Stomach, which flares up and leads to the face.Acupuncture is an effective treatment for reducing TN and is safe, with minimal side-effects that could include possible bruising and/or hematomas at needle insertion points.4 Yin et al.'s literature review shows that acupuncture has been adopted successfully for TN treatment for a long time.5Case StudyA 62-year-old female, with TN for 1month, had pain on the right side of her face, and could not eat or touch her face on that side. She had taken oral painkillers, that were prescribed for her in a primary-care clinic; however, this, unfortunately resulted in her experiencing increased pain. Her clinical symptoms included sharp pain in her face when her mouth was open, headaches, and restless sleep at night. Her tongue was red and dry, and her pulse was wiry.Acupuncture points selected were ST 4 (Dicang), ST 6 (Jiache), ST 7 (Xiaguan), and ST 2 (Sibai), all on the affected side; and bilateral LI 4 (Hegu) and PC 6 (Neiguan). Filiform stainless steel needles (0.25 × 40 mm; Hansol Medical Co., Korea) were inserted to stimulate local points with shallow needling based on the distribution of the nerves in TN. Gentle needling was performed, as deep needling was not required. The needles were retained for 30 minutes. This treatment was provided 3 times per week, and a total of 12 acupuncture sessions were performed.After 12 acupuncture treatments, this patient reported significant pain relief, compared with her initial presentation at the beginning of her course of acupuncture treatment. This clinical experience supports that acupuncture can induce an analgesic effect, especially after multiple repetitions of acupuncture therapeutic sessions.ConclusionsTN is a chronic, neuropathic pain disorder characterized by spontaneous and elicited paroxysms of electric shock–like or stabbing recurrent pain, in the distribution of 1 or more branches of the trigeminal nerve.6,7 Conventional therapies—such as medication, surgery, and other adjuvant methods—may provide pain relief from TN. However, it is challenging to manage if patients may be poorly compliant with medical care that also entails significant costs to them.8 Hence, a complementary and alternative medical approach, such as acupuncture, can have clinical effectiveness in control