Head and Neck Pain: Hand Tremor with Dental Medicine Implications

Practical Pain Management. Vol.9, No.7 September 2009

by Edwin A. Ernest, III, DMD

This article has a distinctly personal application for me. In May of this year, I experienced elective neurosurgery for a movement disorder defined as Essential Tremor. The disorder of hand tremors in my case was bilateral in nature with the onset of symptoms occurring around age 60. It is believed that approximately 50% of essential tremor patients suffer a genetic-linked cause.

And, in my case the condition was progressively resistant to medication management. A neurologic exam and work-up confirmed the suspected diagnosis. Surgical implantation of electrodes in the brain and a battery controller in the chest has stopped the tremors completely, and has enabled me to resume normal activities of my profession and personal life. An additional test I received before surgery was evaluation for trigeminal nerve involvement as a source of causation. For me the test was negative. Why was the test done? Because there is more to the movement disorder story than meets the eye.

Many of us know that certain medications and mandibular vertical dimension problems can cause symptoms of oro-facial dyskinesia, a movement disorder of the mandible and often the tongue. It is a debilitating condition. What is not generally known is that the impact of altered mandibular vertical dimension can also cause even more complex whole-body effects. Brendan C. Stack, DDS, MS, of Vienna Virginia,1 has done much of the research on trigeminal nerve-related hand and body tremors and his successful work includes treatment of Tourrette’s syndrome as well. I could wish that my case of tremors was trigeminal nerve in origin since the treatment would be non-surgical, but I have learned a lot about centrally-mediated hand tremors and, because of that knowledge—together with Dr Stack’s research—I am able to describe for you the following case of right hand tremor of cervical and trigeminal origin.

Post-Traumatic External Nasal Pain Syndrome (a Trigeminal Based Pain Disorder)

Post-Traumatic External Nasal Pain Syndrome (a Trigeminal Based Pain Disorder)
Headache: The Journal of Head and Face Pain
Volume 49 Issue 8, Pages 1223 - 1228
Todd Rozen, MD
From the Michigan Head Pain & Neurological Institute – Neurology, Ann Arbor, MI, USA.
Correspondence to T. Rozen, Michigan Head Pain & Neurological Institute, 3120 Professional Drive, Ann Arbor, MI 48104, USA.
Conflict of Interest: None

Copyright Copyright © 2009 American Headache Society
KEYWORDS
trigeminal nerve • facial pain • headache • nasal pain • sphenopalatine ganglion
(Headache 2009;49:1223-1228)

ABSTRACT
Little has been written about persistent external nasal pain after injury to the nose in the neurologic or headache literature. In clinical practice, this can be a disabling and treatment refractory condition. The external portion of the nose is highly innervated by branches of the ophthalmic and maxillary divisions of the trigeminal nerve including the nasociliary nerve, external nasal nerve, infratrochlear nerve, anterior ethmoidal nerve, and infraorbital nerve. As these nerves are located on the external portion of the nose just deep enough to the skin they can be easily traumatized with any impact to the nose.

Four patients with what is termed the post-traumatic external nasal pain syndrome are reported in this paper, describing the clinical presentation of the disorder and providing treatment options. Post-traumatic external nasal pain syndrome appears to be a novel form of trigeminal-based pain not previously reported in the neurologic literature.


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Accepted for publication May 18, 2009.

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1526-4610.2009.01485.x About DOI