I get a surprisingly high number of questions about trigeminal neuralgia asking if there is a role for the amino acids GABA or tryptophan to help ease some of the nerve and associated face pain. It’s surprising because trigeminal neuralgia is considered a rare neurological disorder.
Nerve pain is not my area of expertise (anxiety is), and because anxiety and depression is common in this population, there are very likely similar underlying causes (more on that below). The targeted individual amino acids that we use for anxiety, also help to ease pain, so I’m sharing some of what I know in case it helps you or a loved one.
Read on to learn more about this condition and GABA, tryptophan, DPA, acupuncture, St. John’s Wort, Lyme disease, herpes and B vitamins.
About trigeminal neuralgia and the incidence
The NIH fact sheet defines trigeminal neuralgia (TN) as
a chronic pain condition that affects the trigeminal or 5th cranial nerve, one of the most widely distributed nerves in the head. TN is a form of neuropathic pain (pain associated with nerve injury or nerve lesion.) The typical or “classic” form of the disorder (called “Type 1” or TN1) causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episode. These attacks can occur in quick succession, in volleys lasting as long as two hours. The “atypical” form of the disorder (called “Type 2” or TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than Type 1. Both forms of pain may occur in the same person, sometimes at the same time. The intensity of pain can be physically and mentally incapacitating.
The incidence of new cases is approximately 12 per 100,000 people per year and women are impacted more than men.
A number of studies show anxiety, depression and insomnia are common when someone has trigeminal neuralgia. The question is this – is the pain causing the anxiety, depression and insomnia OR are there common underlying physiological causes for both. It’s likely a combination of both especially when it comes to idiopathic trigeminal neuralgia i.e. when there is no known cause. Known causes include head injury, multiple sclerosis, dental procedures, tumors and cysts.
By using some of the approaches outlined below, we may see pain relief and improved mood, less severe anxiety and better sleep.
When to consider GABA and serotonin support
There is no research on either GABA or tryptophan/5-HTP helping with symptoms of trigeminal neuralgia, however medications that work on both GABA and serotonin are typically prescribed for trigeminal nerve pain. For this reason I would consider a trial of GABA and/or tryptophan (or 5-HTP if other low GABA physical anxiety symptoms and low serotonin worry-type anxiety symptoms are also present. You can find the symptoms list here.
There is research-based and clinical evidence that GABA and serotonin support help with other types of pain:
- Tryptophan ends TMJ pain, headaches and worry, and improves mood and sleep: a success story
- GABA lozenge relieves excruciating pelvic floor/rectal pain and spasms within 30 seconds: a solution for proctalgia fugax
Both help with the anxiety, low mood and insomnia that is often present with pain conditions like this.
St. John’s Wort for nerve pain and mood
In one case report, Hypericum perforatum (St. John’s Wort) as a possible therapeutic alternative for the management of trigeminal neuralgia (TN), a 53-year-old Hispanic female patient with a history of trigeminal neuralgia used an over-the-counter preparation of St. John’s Wort and found it relieved her pain completely.
St. John’s Wort is a herb that is primarily “used for depression but also is used for rheumatism, gastroenteritis, headache and neuralgias. ” This case report is one of many studies on this herb and trigeminal neuralgia and other neuralgias (nerve pain).
It has anti-inflammatory and antioxidant effects and also supports serotonin and GABA production which further supports the above recommendations to trial the amino acids. GABA and tryptophan would also be safe options if St. John’s Wort can’t be used as in the case of blood thinners, the birth control pill and other medications
Pain relief with endorphin support: acupuncture and DPA
Acupuncture offers pain relief via endorphin boosting and can be an option for the treatment of trigeminal neuralgia, also offering relief for the “secondary myofascial pain associated with it.”
DPA (d-phenylalanine) is an endorphin-boosting amino acid that may also offer some pain relief. It can also be used to wean off prescription pain medication and improve sleep.
Other research-based pain-relief approaches for trigeminal neuralgia
Physical therapy, chiropractic care, using a custom dental appliance, and addressing myofacial pain may offer relief or be part of the solution.
There are some less recognized approaches too:
- Photobiomodulation on trigeminal neuralgia: systematic review “Photobiomodulation appears to be as effective as conventional therapies” that include medications and surgery and yet without the side-effects. Photobiomodulation, also known as red light therapy, is also beneficial for anxiety and mood regulation.
- Palmitoylethanolamide and Its Formulations on Management of Peripheral Neuropathic Pain – Palmitoylethanolamide (shortened to PEA) “has anti-inflammatory and anti-hyperalgesic effects, due to the down-regulation of activation of mast cells”
- Therapeutic potential of cannabinoids in trigeminal neuralgia – there is growing evidence that “cannabinoids may be effective in alleviating neuropathic pain and hyperalgesia [extreme pain sensitivity]” via “inhibiting neuronal transmission in pain pathways.”
All of the above can also improve mood and insomnia and reduce anxiety too.
Other factors to consider: B vitamins, Lyme disease, herpes and gluten
As with any condition, a full functional medicine work up should be done to rule out and/or address gluten issues, low vitamin B6/B1/B12, and even herpes zoster and Lyme disease as a root cause (or contributing factor).
Current approaches and emerging interventions – disappointing for a 2021 paper
I was excited to read the title of this paper, Trigeminal Neuralgia: Current Approaches and Emerging Interventions, published late this year. The authors share that it “summarizes over 150 years of collective clinical experience in the medical and surgical treatment of trigeminal neuralgia.”
What is disappointing is there is no mention of any of the approaches listed in this blog. It’s published by neurosurgeons so it is understandable that they would say: “The first-line treatment remains anticonvulsant medical therapy. Patients who fail this have a range of surgical options available to them.”
Medications and/or surgical options may work well for you but if not, you need to know there are other options. You may also be looking for a medication-free or non-invasive approach.
Keep in mind that this is what you’ll be offered unless you work with a functional medicine practitioner.
I do agree with and am encouraged by these statements:
- What is increasingly clear is that there is no catch-all medical intervention that is effective for all patients with trigeminal neuralgia, likely reflective of the fact that it is likely a heterogenous group of disorders that jointly manifests in facial pain.
- Ultimately, elucidation of the molecular mechanisms underlying trigeminal neuralgia will pave the way for novel, more effective and less invasive therapies.
Complementary approaches: NIH fact sheet
What is encouraging is that the NIH fact sheet I link to above, does mention low-impact exercise, yoga, creative visualization, aromatherapy and meditation.
Other than the standard medications (carbamazepine, oxcarbazepine, topiramate, gabapentin, pregabalin, clonazepam, phenytoin, lamotrigine and valproic acid and tricyclic antidepressants such as amitriptyline or nortriptyline) and surgical options they do also mention acupuncture, chiropractic, biofeedback and nutrients.
Botox is listed too but I have concerns about this approach.
This blog is not intended to be a comprehensive approach for pain relief for trigeminal neuralgia but rather some options you can consider and explore with your practitioner – especially when you also have anxiety, depression and insomnia too.
Resources if you are new to using tryptophan/5-HTP, GABA and DPA as supplements
If you are new to using the amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see the low serotonin, low GABA and low endorphin symptoms) and a brief overview here: Anxiety and targeted individual amino acid supplements: a summary.
If you suspect low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids so you are knowledgeable. And be sure to share it with the team you or your loved one is working with.
The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acid products that I use with my individual clients and those in my group programs.
Has any of the above approaches helped you or your loved one? If not, what has helped you?
What conventional treatment have you had and did it help? Were you offered any of the above non-medication and non-surgical treatment approaches?
If you’re a practitioner, has any of this helped? Please share your treatment approaches too.
Feel free to ask your questions here too.
It’s important to also remember that Trigeminal Neuralgia is prominent in MS patients. Pubmed research has shown high doses of B12 (15,000mcg)/day has shown nerve repair. We know b/c we implemented this protocol with my husband who had Trigeminal Neuralgia & pain has literally disappeared within 2 weeks. We also used Calcium EAP (known to help repair myelin). I keep him on 5-htp as well as Pureform omega 3 oils.
Natalie
I’m so glad to hear B12 and this high dose helped your husband so quickly. Does he have MS and how much Calcium EAP do you use?
And yes you are correct “Trigeminal neuralgia is one of the most characteristic and difficult to treat neuropathic pain conditions in patients with multiple sclerosis.” https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-019-0969-0.
This paper only mentions medications and surgery. Can you please share a link to the paper recommending 15,000mcg B12?
May I ask what benefits he’s seen from 5-HTP?
Hi Natalie,
Is there a way to contact you to learn about the B12 combo you did? i am suffering so badly in my eye and gums and plan on trying B12 daily injections. I pray you see this.
I just received the dx of TN. My doctor has suggested Carbamazipine I do not want to take it. I have made an appt with a functional medicine doctor. In the meantime I am doing research. I cannot find the article about the vitamin B12 dose. Can you help? Pat Messier.
Pat
I think this may be what Natalie is referring to https://www.linkedin.com/pulse/new-information-post-stroke-rehabilitation-using-multiple-tun
Can I use tryptophan while taking temazepam 10mg? I have been taking temazepam for 20 years and would like help to taper and eventually be off them.
Margie
There is no known issue with tryptophan being used with temazepam (which is a benzodiazepine) but it’s always best to discuss with the prescribing doctor. Have you been prescribed temazepam for your trigeminial neuralgia and does it help?
Thank you Trudy.
I take the temazepam for a long standing sleeping problem. I had a wonderful naturopath relieve my trigeminal neuralgia after having shingles.
Margie
Glad you found relief. We’d love to hear what your naturopath recommended for the trigeminal neuralgia after you had shingles.
I have my clients get nutritionally stable BEFORE starting any medication taper (with their doctor’s approval of course) and this prevents many of the adverse effects. This means eating real food, no gluten, no caffeine, no sugar, quality animal protein, eating for blood sugar control and addressing gut health, the adrenals etc (everything I cover in my book “The Antianxiety Food Solution” – more here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/). And then we use the amino acids during the taper (all with the doctor’s approval and monitoring).
I have found that GABA and/or theanine and tryptophan and/or 5-HTP help a great deal. We may also include melatonin, niacinamide, St John’s Wort, adrenal supportive nutrients and other protocols based on each person’s unique needs.
However there are a subset of individuals (about 30%) who do have a much more difficult time tapering benzos than others, even with nutritional support. More on this here https://www.everywomanover29.com/blog/world-benzodiazepine-awareness-day-say-no-benzodiazepines-anxiety/
It’s very common for benzos to be less effective as the years go by and actually start to cause more severe anxiety, insomnia and muscle pain (and many other distressing symptoms). Benzo Information Coalition is an excellent resource https://www.benzoinfo.com/
Thanks for covering trigeminal neuralgia Trudy, it is so painful and difficult to live with. Looking forward to trying your suggestions. Mine is caused by a meningioma skull base tumor. I tried botox and that did not relieve my pain at all, not to mention only one side of my mouth moving when I spoke. Is there a blood test to determine amino acid levels? (I’m in Australia)
Louise
Sorry to hear and thanks for sharing about botox not helping. Even with a meningioma some of these approaches may alleviate some pain. Please keep us posted.
There is no blood test to determine amino acid levels. The best way to determine if someone may have low GABA/serotonin is to look at the low GABA/serotonin symptoms, rate them on a scale of 1-10 with 10 being worst, do a trial of the respective amino acid and rate the symptoms again right afterwards (in the next 2 to 30 minutes). Here are the symptoms https://www.everywomanover29.com/blog/amino-acids-mood-questionnaire-from-the-antianxiety-food-solution/
If you are new to the amino acids and also have anxiety symptoms my book “The Antianxiety Food Solution” is a great place to start (and well as a chapter on the amino acids, there are chapters on other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc). More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
Thank you for addressing TN. I have been dealing with it for over 20 years. Sometimes the pain occurs every 3 minutes and last for one minute. It is so intense that that my whole body is affected and remains tensed in the two minute interim without pain. Typically this will last for about 6 days and nights before I get enough of a break to take a nap. I will go 6 days and nights with no sleep and even afterwards it might take a month to get 6 hours of sleep at one time. On a good day I can talk and brush my teeth. I do think it is more common that the books say, because I have met a number of others who suffer with it. My “functional” doctor recommended surgery. But it seems that those who do have surgery, have to repeat it in about 7 years. I will read this again and try again some of your combinations of supplements.
Anne
Sorry to hear. Do you know the cause or has it been called idiopathic/of unknown cause? When I read about the body tension it’s a clue GABA may help this aspect, and both GABA and tryptophan may help with the sleep issues. Hopefully the amino acids and some of these other approaches will help with the pain too. Please keep us posted.
If you are new to the amino acids and also have anxiety symptoms my book “The Antianxiety Food Solution” is a great place to start (and well as a chapter on the amino acids, there are chapters on other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc). More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
I REALLY ENJOY YOUR EMAILS AND I WANT TO WISH YOU A HAPPY AND HEALTHY NEW YEAR
Thanks John – and a happy and healthy new year to you too!
Thanks for addressing alternative ideas for trigeminal neuralgia. It is an awful! condition – I’ve put up with it from 2004 ’til 2019 with no meds. In 2019 I was put on carbamazepine which induced neuropathy (a rare side effect of carbamazepine). Weaned off of it to lamotrigine. Neuropathy disappeared within days of being totally off the carbamazepine. The idiopathic trigeminal pain is extreme when it flares up – I will spare the details. I look forward to trying something for low catecholamines – I have every symptom you listed for low catecholamines plus ‘feeling fearful and worried’ 100% induced by the pain – It’s scary! What will my future look like if I can’t find relief? I never thought in a million years that I would be so tied to a pharmaceutical drug, but that’s where I am. What do you recommend for low catecholamines.
Sangita
Glad to hear the neuropathy resolved. Unfortunately, as with all meds, Carbamazepine, does have many side-effects. This one has mood impacts too (https://www.drugs.com/sfx/carbamazepine-side-effects.html) and so does lamotrigine (https://www.drugs.com/sfx/lamotrigine-side-effects.html) – the fear and worry may be triggered by this as well as the pain and very possibly low GABA/low serotonin too. Hopefully the options in this blog give you some hope and options for exploration with your practitioner.
The best way to determine if someone may have low catecholamines is to look at the symptoms, rate them on a scale of 1-10 with 10 being worst, do a trial of tyrosine and rate the symptoms again right afterwards (in the next 2 to 30 minutes). Here are the symptoms https://www.everywomanover29.com/blog/tyrosine-focus-motivation-energy-good-mood-possibly-even-anxiety/
This may be helpful – https://www.everywomanover29.com/blog/tyrosine-focus-motivation-energy-good-mood-possibly-even-anxiety/ We always review the precautions before considering tyrosine.
If you are new to the amino acids (and other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc) my book “The Antianxiety Food Solution” is a great place to start. More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
Trudy, yet another amazing, comprehensive article on this complex topic! My brother had TN for most of his adult life until about 15 years ago he had brain surgery to address pressure on the nerve from an adjacent, oversized artery. These less invasive strategies may save many people from years of pain – thank you!!!
Hi, I am Pat Anderson’s brother who suffered from TN for 22 years until my successful surgery. I would have tried – and did try – ANYTHING to address my TN. To clarify my nerve was impacted by an abnormally large vein. I was very fortunate that I consulted with a neurosurgeon who had extensive experience with TN, as he alone was able to observe the nerve impact point (several others had failed to find it). I was lucky because I was told that most of the time the cause cannot be determined. My neurosurgeon had planned to simply resect the vein, but it was so large he opted to cushion the nerve/vein impact with a surgical sponge rather than risk a problem with resection. Before this was resolved I lived in dread every day of showering, washing my face, brushing my teeth, chewing, or even a gentle breeze blowing across my mustache. Like so many illnesses/physical ailments, you really cannot appreciate how detrimental TN is unless you’ve had it yourself. Even 15 years later, I brace myself for when the shower droplets first hit my face. Thank you Pat for sharing this link with me. I sincerely hope a TN sufferer finds some value in hearing about my own experience.
Michael
Thanks for sharing your experiences. I’m so glad you found success with surgery. Living so long with a chronic condition like this is very traumatic. When I hear ” I brace myself for when the shower droplets first hit my face” I wonder if EFT/Tapping (https://www.everywomanover29.com/blog/tapping-or-eft-for-reducing-anxiety-depression-pain-and-cravings-plus-physiological-changes-in-cortisol-heart-rate-blood-pressure-and-siga/) or EMDR may be worth exploring.
I would love to hear what you did try before the surgery. I’m curious if any of these options were discussed with you?
Pat
Yes, hopefully these strategies may help many from years of pain. I’m so glad your brother found success with surgery and thanks for sharing this blog with him
Hi Trudy,
I am a licensed acupuncturist in CA, USA.
When I used to take GABA for my stress, my body/brain reacted some tingling sensation.
It was so awkward and uncomfortable.
I thought it was only me, but when I prescribed to my patients, they also felt the same.
Can you tell me why this reaction occurred.
If you know the solution, pls. share with us.
Thank you so much for your generosity and deep research.
Naomi
This can happen when too much GABA is used or if GABA is not needed. I typically hear of this happening when 500mg to 750mg is used to start. It’s also often described as a niacin-like flush or tingles. With GABA, 125mg is a typical starting dose and it’s always used as a sublingual or capsule opened on to the tongue. We slowly go up from there based on symptoms and it’s unique to each person’s needs.
Please do share which product/s you used, the dosing and let us know if you do better with a lower dose.
I do offer amino acid training for practitioners. As well as the valuable content, it’s an opportunity to interact with me and other practitioners who are also using the amino acids. More here https://www.anxietynutritioninstitute.com/balancingneurotransmitters/
I’d love to hear if you’ve had success with trigeminal neuralgia with acupuncture?
Hi Trudy,
Thanks for your response and explanations.
The Gaba I used for me and my patient is from Pure Encapsulations.
This Gaba contains 700 mg per capsule, which may too much for the start.
Which brand would you recommend for practitioner use?
Regarding Trigeminal neuralgia with acupuncture, I have not seen any for this symptom, but I am sure acupuncture will be helpful. Any facial pains, including TMJ, Bells Palsy, Ticks will be relieved by acupuncture.
Naomi
Yes 700mg is way too much to start for most people. The companies are at fault for having such high dose products and stating “1 capsule daily, between meals, or as directed by a health professional.”
I am curious to hear where you learned about using GABA and if the recommendation was to use a high dose like this?
I have clients open up the capsule and start with 125mg and increase from there. You can find other products I recommend here https://www.everywomanover29.com/blog/amino-acids-pyroluria-supplements/
Please keep us posted on how you and your clients do with a lower dose.
And I do hope you’ll consider the practitioner training as there are many nuances and best practices when using the amino acids.
If you don’t yet have it, my book “The Antianxiety Food Solution” is also an excellent resource with an entire chapter on the amino acids. More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
Thanks for the additional feedback on acupuncture – I’m a big fan!
Is it going to stress?
This article explains it. If you are already under stress, GABA can go from a shunt to glutamate instead of GABA.
How to Increase GABA and Balance Glutamate
https://www.holistichelp.net/blog/how-to-increase-gaba-and-balance-glutamate/
hy
I TN, I tried several things to relieve pain but with minimal relief. One day I stumbled on a video from an upper cervical chiropractor claiming he had helped several people with TN. So I found one about 30 miles from away. An amazing man that never gave up until he found what helped. Turned out adjusting my skull plates helped immencly. Misalignment was putting pressure on the nerve. He saved my life. I know of another lady that got relief from a chiropractor as well. Not the it will help every one but it’s definitely worth trying. Hope this helps.
Jack
Thanks for sharing and so glad to hear this chiropractic approach helped you and your friend. I am curious to hear what else you tried.
Dear Trudy,
Thank you for writing this very informative and useful article. I have been suffering from TN/facial pain for about 4 years now. It is absolutely horrible, even when it is not actually painful, because of the constant fear it creates that it can come back at any time. The lack of control or knowledge over the contributing factors does not help. I am still very young so very worried about my future, as I have already lost strength to tackle both this and my work at the same time.
I was able to identify one area as being the problem, which led me to believe that the problem was somewhat of a dental nature. The pain starts / increases when I press on one of my superior central incisor, which had a root canal done a couple of years ago. I can tap on all of the other teeth without provoking the pain, but this one I cannot stimulate without risking a TN crisis.
Whenever my facial pain was starting again, I would put a few drops of roman chamomile on my jaw around that tooth (or just do chamomile tea or pharmacy anti-inflammatory mouth wash), several times a day, and it would eventually stop the pain from spreading to my face. I was able to be almost free of facial pain for about a year thanks to this trick, but the tooth always remained painful & tender on stimulation. What also helped was filing the tooth below this one, to prevent them from hitting each other, as well as wearing a anti-bruxism guard during the night, to avoid any stimulation on the painful tooth. I also did physiotherapy for my TMJ issues but unsure how much this actually helped.
A couple of days ago I decided to take my courage in both hands and have an apicoectomy done to this tooth to complete the treatment. Immediately regretted this decision. It is still healing, so we will see, but it definitely triggered my TN again.
My dentist thinks there is a chronic inflammation on the top or around this tooth (which led to me doing the apicoectomy), my facial surgeon thinks it is a mix of TMJ symptoms & the tooth is acting as the receptacle of my pain because it is the only one with a root canal, my neurologist thinks that “it is just something we might never know what the cause is” (very useful), and my physical therapist thinks it might be TMJ and some associated myofascial pain.
I personally think there is some sort of chronic inflammation around this tooth or small nerves damage around the root of this tooth. I was wondering whether you have seen this phenomenon in some of your patients (TN with one single tooth as a trigger)? I have listed a lot of remedies (supplements / therapies) I have not yet tried, some inspired by your article (thank you!) and some found in literature, testimonials or forums, and I am unsure what to start with to be honest.
What supplements would you recommend I take to speed up nerve repair? I already take a combo of magnesium (150 mg), vitamin D (4000 ug), iron (12 mg), Vit B1, Vit B6, Potassium, Vit C and Zink. I just finished a 2 months cure of Vit B12 (3 µg).
Thank you in advance for your response!
Marie
Marie
This is new to me but given what I know about root canals I’m not surprised. The fact that you’ve made the connection is a great start. I’d explore acupuncture and St. Johns Wort and the herbs used for diabetic nerve injury