Trigeminal neuralgia is a disorder of the trigeminal nerve that produces paroxysmal, intense, knife-like pain, lasting from a few seconds to 2 minutes in a single bout, located in the area innervated by one or more sensory branches of the trigeminal nerve, most commonly in the area of the maxillary branch. The presence of arterial collaterals and, less commonly, venous collaterals that produce compression of the trigeminal nerve root where it enters the brainstem is found during surgery or pathologic autopsy, suggesting that trigeminal neuralgia is a compressive neuropathy. The disease usually affects adults, especially the elderly. Pain episodes are often triggered by touching some of the plateau points or by activity (e.g., chewing or brushing teeth). Although each episode of severe pain is brief, multiple episodes of severe pain in a row can prevent the patient from engaging in normal activities. Diagnosis The diagnosis is usually made on the basis of a typical medical history. Trigeminal neuralgia is not associated with objective clinical or pathological signs, so if objective sensory disturbances or cranial nerve abnormalities are found, the structural lesion causing the pain must be searched for, such as tumors, plaques of multiple sclerosis or other lesions compressing the trigeminal nerve or trigeminal pathways of the brainstem. Pontocerebral lesions usually cause sensory plus motor dysfunction; medullary lesions cause only loss of nociceptive and temperature sensation with loss of corneal reflexes. The differential diagnosis includes tumors, brainstem vascular malformations, acute cerebrovascular disease, and multiple sclerosis (especially in younger cases). Postherpetic pain has a typical prior history of herpes zoster, crusted scarring, and a predilection for the ophthalmic branch of the trigeminal nerve. Trigeminal neuropathy can be seen in Sj?gren’s syndrome or rheumatoid arthritis, but sensory disturbances are often located in the perioral and nasal regions. Migraine can cause atypical facial pain that is normal on clinical physical examination, but the pain is more persistent and is burning or throbbing. Treatment Currently, carbamazepine 200mg 3-4 times a day is used clinically; however, liver function and hematopoietic function should be tested regularly. If carbamazepine is ineffective or produces toxic reactions, other drugs that can be used are phenytoin sodium 300~600mg/d, baclofen 30~80mg/d, or amitriptyline 25~200mg/d, taken at bedtime. Closure of the peripheral branches of the trigeminal nerve can only provide temporary relief. In refractory cases, craniotomy may be performed to isolate the pulsatile arterial collaterals compressing the trigeminal roots by moving them within the posterior cranial recess (Janetta procedure). Electrolytic, chemical or balloon compression lesions of the semilunar (trigeminal) ganglion can be caused by percutaneous puncture with a special puncture needle guided by a stereotactic technique. Occasionally, as a last resort in the treatment of intractable pain, the trigeminal nerve root between the semilunar ganglion and the brainstem is surgically severed. Fire acupuncture treatment Trigeminal neuralgia is a stubborn and intractable condition for which the usual treatment options are ineffective and unsustainable. Ordinary acupuncture treatment cannot cure it. Fire acupuncture is currently a more effective treatment. However, fire acupuncture can be intimidating for the first time, but the method is safe and effective. After receiving the fire needle treatment, if the needle holes appear high protrusion, redness, itching, is the body’s normal reaction to the fire needle, do not scratch. Because fire needling is carried out after high temperature heating, the possibility of infection is extremely small. Do not take a shower on the day after the needle, so as not to contaminate the needle hole. Fire needling is usually treated every 3~7 days.