Does CBD Oil Work for Trigeminal Neuralgia?

  • Trigeminal Neuralgia (TN) is caused by damage or dysfunction in the trigeminal nerve, resulting in severe pain on the face. 
  • Cannabidiol (CBD) may have therapeutic effects in pain management by modulating receptors in the ECS (1). A study from Pharmacological Reviews showed that CBD might strengthen nerve impulse in the ECS receptors, resulting in analgesic potency (2)
  • A review shared that CBD might be useful in alleviating neuropathic pain and hyperalgesia (pain sensitivity) (3)
  • Researchers observed that high blood pressure increases the risk of TN. A 2017 preclinical study showed that CBD reduced the resting blood pressure of human subjects (4).
  • However, more studies are needed to support CBD’s benefits to people with trigeminal neuralgia. 

Why People Are Turning to CBD Oil for Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a form of neuropathic pain condition caused by dysfunction in the trigeminal nerve. The nerve is responsible for carrying sensation signals from the face to the brain.

TN pain has been reported to be so severe that it has been called the “suicide disease(5).

Slight stimulations on the face, such as touching, brushing, and washing may cause severe facial pain. TN may also cause muscle spasms, feelings of electric shock, and burning sensation.

TN symptoms include anticonvulsant agents, antispasmodic agents, surgery, and other procedures that involve inserting a stent into the trigeminal nerve.

Antiepileptic medications, such as gabapentin and carbamazepine, have been used to treat TN (6). However, the lack of intolerability and efficacy has been observed among these medications after prolonged use (7).

CBD is a proven antiepileptic treatment (8). A recent study posted in Molecules mentioned evidence of CBD’s anticonvulsant and neuroprotective properties. These actions might help reduce spasms (9).

Studies have not investigated CBD’s efficacy on spasms caused by TN. However, CBD might have therapeutic benefits for treating chronic pain caused by TN (10).

A review shared that cannabinoids, such as CBD, might help alleviate neuropathic pain and hyperalgesia (pain sensitivity). The review mentioned that there is evidence that cannabinoids might block the pain pathway’s neural transmission (11).

The authors added that the nociceptive effects produced by cannabinoids might be a potential therapeutic approach to the management of trigeminal neuralgia (12).

The analgesic and anti-hyperalgesic effects of CBD were supported by an animal study published in the Journal of Experimental Medicine (13).

The study mentioned that CBD possesses therapeutic benefits that might reduce pain and inflammation caused by neuropathy (14).

Neuropathy is dysfunction or damage in the nerves that may cause pain, tingling and burning sensations, numbness, or muscle weakness.

Moreover, the authors added that CBD was able to mitigate hyperalgesia in mice models. The study concluded that CBD reduced persistent inflammation and neuropathic pain(15).

Another study shared in the European Journal of Pharmacology demonstrated that CBD possesses potent anti-inflammatory and immunomodulatory effects (16).

In the study, oral CBD was administered on rat models with induced sciatic nerve compression. Researchers found that CBD treatment reduced hyperalgesia and reduced inflammation (17).

According to experts, trigeminal nerve pain can be caused by a blood vessel pressing on the trigeminal nerve. This compression causes damage to the trigeminal’s protective coating (myelin sheath) (18).

Moreover, researchers observed that high blood pressure increases the risk for TN (19).

A preclinical study acknowledged that CBD has cardiovascular benefits (20). The authors mentioned that healthy volunteers (age 21-29) whose hypertension is triggered by stress displayed a lower resting blood pressure after taking CBD.

Clinical studies without limitations are needed to demonstrate CBD’s ability to reduce blood pressure in older individuals.

Most of the studies mentioned have shown results using animals as test subjects. More clinical studies are needed to prove CBD’s efficacy in alleviating nerve pain.

How CBD Oil Works to Help With Trigeminal Neuralgia

The endocannabinoid system (ECS) is essential in maintaining homeostasis in the central nervous system, peripheral nervous system, immune system, and organs.

The ECS is composed of receptors that are spread across the human body. These receptors include the cannabinoid receptors (CB1 and CB2) and glycine receptor (GLyR) (21).

Studies acknowledged that modulating the receptors in the ECS might influence bodily functions, resulting in several therapeutic benefits (22).

Modulatory effects can be triggered or stimulated by cannabinoids, such as cannabidiol (CBD), tetrahydrocannabinol (THC), cannabichromene (CBC), cannabinol (CBN), and cannabigerol (CBG) (23).

A study posted by the Journal of Experimental Medicine suggested that modulating the ECS might have therapeutic effects in pain management (24).

Moreover, the authors mentioned that glycine receptors in the central nervous system are an essential target for alleviating neuropathic pain (25).

The authors added that cannabinoids, such as THC and CBD, might strengthen nerve impulses in the glycine receptors, resulting in analgesic potency (26).

Glycine receptors are ion channels that are responsible for neurotransmission.

The study found that oral CBD treatment provided a binding glycine activity that reduced hyperalgesia and neuropathic pain in mice models.

The Pros and Cons of CBD Oil for Trigeminal Neuralgia

The Pros

  • Studies demonstrated that CBD might have therapeutic effects in pain management by modulating receptors in the ECS (27).
  • Researchers acknowledged that CBD might strengthen nerve impulses in the ECS receptors, resulting in analgesic potency (28).
  • Animal studies have shown that oral CBD treatment might be useful in alleviating neuropathic pain and hyperalgesia (pain sensitivity) (29).
  • Studies have shown that CBD might reduce blood pressure. High blood pressure might increase the risk for TN (30).
  • Researchers acknowledge that CBD is well-tolerated and has an excellent safety profile (31).

The Cons

  • There are not enough clinical studies that support CBD’s efficacy in treating trigeminal neuralgia.
  • Studies mentioned that CBD might cause adverse effects, such as dry mouth, diarrhea, drowsiness, loss of appetite, and CBD-induced drug interactions (32).
  • An animal study has shown that CBD might cause hepatotoxicity (liver damage) when taken in extremely high doses. This hypothesis is supported by the US Food and Drug Administration (FDA) (33).

How CBD Oil Compares to Alternative Treatments for Trigeminal Neuralgia

There are not many alternative treatment options for painful conditions, like TN. The efficacy of alternative anticonvulsants for treating TN is currently not supported by scientific studies.

A popular alternative treatment for TN is acupuncture. A review mentioned that a 66-year woman suffering from TN believed that she was successfully treated by acupuncture (34).

Acupuncture is a Chinese tradition that uses microneedles to balance the energy in the body.

Researchers mention that acupuncture may help maintain homeostasis in the ECS and must be investigated. So far, no direct studies have been made on how acupuncture might trigger the cannabinoid receptors (35).

A study published in Frontiers of Molecular Neuroscience has found that electroacupuncture on osteoarthritis rats was able to increase receptor activity, resulting in reduced chronic pain (36).

Electroacupuncture is conducted by sending electrical signals through acupuncture needles.

CBD has somewhat similar characteristics to electroacupuncture. A study discussed that CBD’s modulation of adenosine receptors resulted in reduced pain and inflammation in rheumatoid arthritis mice (37).

Another alternative treatment for TN is vitamin B12. Studies have shown that vitamin B12 has analgesic properties that might be useful for treating neuropathic pain (38).

A review from Neural Plasticity cited clinical studies that produced positive results from neuropathic patients following treatments of methylcobalamin (MeCbl), a form of B12. These clinical studies included patients with neuropathic health conditions, such as TN and diabetic neuropathy (39).

Clinical studies have yet to test CBD’s efficacy on TN and diabetic neuropathy. However, a study acknowledged that CBD might also possess therapeutic benefits for neuropathic conditions.

CBD’s modulation of glycine receptors resulted in alleviating chronic pain and hyperalgesia in mice models (40).

How to Choose the Best CBD Oil for Trigeminal Neuralgia

Full-spectrum CBD oil carries all the major cannabinoids found in hemp plants, such as CBD, CBG, CBC, and 0.3% THC.

Full-spectrum CBD is recommended for treating neuropathic pain. A study posted in Therapeutics and Clinical Risk Management acknowledged the analgesic effects of other cannabinoids present in hemp (41).

Broad-spectrum CBD contains the same cannabinoids in full-spectrum without THC. Broad-spectrum is recommended for individuals who do not want traces of THC in their system.

Full-spectrum and broad-spectrum types provide individuals with the “entourage effect.” The entourage effect means that all the cannabinoids are working in synergy.

Individuals who cannot tolerate other cannabinoids may opt for CBD isolate. This concentration contains 90% CBD.

Additional tips to consider before buying CBD:

  • Customers may check for cannabinoid concentration in the product by referring to the certificate of analysis (COA).
  • Checking testimonials and reviews from other customers is helpful.
  • Consulting with a neurologist before taking CBD is important.

CBD Dosage for Trigeminal Neuralgia

More clinical trials are crucial in determining the correct CBD dose for health conditions.

The British Journal of Pharmacology published a study that recommended a low dose of less than 1 to 50 milligrams kilograms per day (<1-50mg/kg/d) (42).

Individuals may increase their dose once their bodies get used to having CBD in their system.

Moreover, a clinical study published by the Brazilian Journal of Psychiatry mentioned that a dose-response curve was observed with CBD (43).

The authors explained that 300mg pure CBD treatment produced positive results, while 150mg and 600mg did not produce any changes.

Also, a high dosage of CBD is not recommended. A study released by Molecules observed that extremely high doses of CBD caused hepatotoxicity in rat models (44).

How to Take CBD Oil for Trigeminal Neuralgia

CBD oil may be taken orally in forms of capsules, softgels, and gummies. Individuals may also take CBD capsules, gummies, and other edibles with a glass of water.

A study observed that CBD remained in the system three to four hours after oral intake (45).

Individuals who want a higher potency of CBD may opt for sublingual administration. CBD tinctures may be taken by using an applicator to drop CBD under the tongue.

More studies are needed to determine absorption speed and plasma concentrations for sublingual delivery.

The half-life of sublingual CBD administration has been observed to be dose-dependent. Nevertheless, researchers observed that plasma concentrations are faster when individuals are in a fasted state (empty stomach) (46).

CBD tinctures may have an earthy taste due to the presence of terpenes. Terpenes are aromatic compounds found in the plants.

Some individuals may want the fastest method for pain relief. Thus, CBD vape pens and cartridges may be recommended.

Studies have shown that the lungs can be very efficient in delivering CBD into the bloodstream (47). The authors explained that inhaling CBD through vaporization could deliver plasma concentrations to the body in less than 10 minutes.

However, another study reported that vaping might cause side effects, such as chest pain, shortness of breath, allergic reactions, and chemical irritation (48).

Are CBD Oil and Medical Marijuana the Same?

Some individuals may mistake CBD for medical marijuana. However, these compounds differ in cultivation and concentration.

Medical marijuana or medical cannabis can come from several cannabis strains. The cannabis plant is harvested for its flowers and leaves, after which they are cured and dried for consumption.

CBD is usually extracted from Cannabis sativa, particularly hemp, using CO2 extraction, solvent extraction, or steam distillation.

The extraction method creates a more concentrated version of hemp. The cannabinoids are manufactured into carrier oils, capsules, edibles, vape juice, and other products.

CBD and medical marijuana also differ in terms of THC content.

CBD contains only 0.3% THC or less, making it legal in all 50 US states and territories (49). Meanwhile, some dispensaries sell cannabis products that may contain up to 25-28% THC (50).

Recreational and medical use of marijuana is illegal in the US, except for 11 states. These states may require consumers to procure a medical marijuana card (51).

Although CBD products are legal, the CBD market remains highly unregulated.

Individuals are advised to always look for the certificate of analysis (COA) before buying the product. The COA is a third-party lab test result from ISO-certified laboratories.

These labs test for cannabinoid concentration and harmful chemicals, such as heavy metals, pesticides, and other contaminants.

The COA allows consumers to know that the product is high-quality and safe for humans or pets.

Conclusion

Studies have shown that CBD might be useful in alleviating neuropathic pain and hyperalgesia. This mechanism is due to CBD’s ability to block neural transmission in the pain receptors (52).

Researchers also acknowledged that CBD might produce analgesic potency by strengthening nerve impulses in glycine receptors (53).

Moreover, studies have shown that CBD might indirectly reduce TN pain by lowering blood pressure (54).

More direct studies are needed to prove CBD’s efficacy in alleviating neuropathic pain.

However, researchers mention that CBD’s therapeutic potentials showed promise in improving the quality of life of individuals with TN (55).


 

  1. Xiong, W., Cui, T., Cheng, K., Yang, F., Chen, S. R., Willenbring, D., Guan, Y., Pan, H. L., Ren, K., Xu, Y., & Zhang, L. (2012). Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors. The Journal of experimental medicine, 209(6), 1121–1134. https://doi.org/10.1084/jem.20120242
  2. Pacher, P., Bátkai, S., & Kunos, G. (2006). The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacological reviews, 58(3), 389–462. https://doi.org/10.1124/pr.58.3.2
  3. Liang, Y. C., Huang, C. C., & Hsu, K. S. (2004). Therapeutic potential of cannabinoids in trigeminal neuralgia. Current drug targets. CNS and neurological disorders, 3(6), 507–514. https://doi.org/10.2174/1568007043336833
  4. Turner CL, Mendoza N, Illingworth RD, et alMeasurement of pulse pressure profiles in patients with trigeminal neuralgiaJournal of Neurology, Neurosurgery & Psychiatry 2003;74:533-535
  5. Adams, H., Pendleton, C., Latimer, K., Cohen-Gadol, A. A., Carson, B. S., & Quinones-Hinojosa, A. (2011). Harvey Cushing’s case series of trigeminal neuralgia at the Johns Hopkins Hospital: a surgeon’s quest to advance the treatment of the ‘suicide disease’. Acta neurochirurgica, 153(5), 1043–1050. https://doi.org/10.1007/s00701-011-0975-8
  6. The Mayo Clinic. Trigeminal Neuralgia Treatment. Retrieved from https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/diagnosis-treatment/drc-20353347
  7. Cramer JA, Mintzer S, Wheless J, Mattson RH. Adverse effects of antiepileptic drugs: a brief overview of important issues. Expert Rev Neurother. 2010;10(6):885-891. doi:10.1586/ern.10.71
  8. The U.S. Food and Drug Administration.The FDA Approves First Drug Comprised of Cannabinidiol. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms
  9. Silvestro, S., Mammana, S., Cavalli, E., Bramanti, P., & Mazzon, E. (2019). Use of Cannabidiol in the Treatment of Epilepsy: Efficacy and Security in Clinical Trials. Molecules (Basel, Switzerland), 24(8), 1459. https://doi.org/10.3390/molecules24081459
  10. Liang, Y. C., (2004). Op cit.
  11. Ibid
  12. Ibid
  13. Xiong, W., (2012). Op cit.
  14. Ibid
  15. Ibid
  16. Barbara Costa, Anna Elisa Trovato, Francesca Comelli, Gabriella Giagnoni, Mariapia Colleoni, (2007). European Journal of Pharmacology. The non-psychoactive cannabis constituent cannabidiol is an orally effective therapeutic agent in rat chronic inflammatory and neuropathic. Pain. Volume 556, Issues 1–3. Pages 75-83, ISSN 0014-2999, https://doi.org/10.1016/j.ejphar.2006.11.006.
  17. Ibid
  18. Trigeminal Neuralgia Overview. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet#:~:text=TN%20can%20be%20caused%20by,nerve%20(the%20myelin%20sheath).
  19. Turner, C. L., Mendoza, N., Illingworth, R. D., & Kirkpatrick, P. J. (2003). Measurement of pulse pressure profiles in patients with trigeminal neuralgia. Journal of neurology, neurosurgery, and psychiatry, 74(4), 533–535. https://doi.org/10.1136/jnnp.74.4.533
  20. Jadoon, K. A., Tan, G. D., & O’Sullivan, S. E. (2017). A single dose of cannabidiol reduces blood pressure in healthy volunteers in a randomized crossover study. JCI insight, 2(12), e93760. https://doi.org/10.1172/jci.insight.93760
  21. Zou, S., & Kumar, U. (2018). Cannabinoid Receptors and the Endocannabinoid System: Signaling and Function in the Central Nervous System. International journal of molecular sciences, 19(3), 833. https://doi.org/10.3390/ijms19030833
  22. Lu, H. C., & Mackie, K. (2016). An Introduction to the Endogenous Cannabinoid System. Biological psychiatry, 79(7), 516–525. https://doi.org/10.1016/j.biopsych.2015.07.028
  23. Pacher, P., Bátkai, S., & Kunos, G. (2006). The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacological reviews, 58(3), 389–462. https://doi.org/10.1124/pr.58.3.2
  24. Xiong, W., (2012). Op cit.
  25. Ibid
  26. Ibid
  27. Ibid
  28. Pacher, P., (2006). Op cit.
  29. Liang, Y. C., (2004). Op cit.
  30. Turner, C. L., (2003). Op cit.
  31. Iffland, K., & Grotenhermen, F. (2017). An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis and cannabinoid research, 2(1), 139–154. https://doi.org/10.1089/can.2016.0034
  32. Huestis, M. A., Solimini, R., Pichini, S., Pacifici, R., Carlier, J., & Busardò, F. P. (2019). Cannabidiol Adverse Effects and Toxicity. Current neuropharmacology, 17(10), 974–989. https://doi.org/10.2174/1570159X17666190603171901
  33. FDA. What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD. Retrieved from https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis
  34. Sert, H., Usta, B., Muslu, B., & Gözdemir, M. (2009). Successful treatment of a resistance trigeminal neuralgia patient by acupuncture. Clinics (Sao Paulo, Brazil), 64(12), 1225–1226. https://doi.org/10.1590/S1807-59322009001200014
  35. Ibid
  36. Yuan, X. C., Zhu, B., Jing, X. H., Xiong, L. Z., Wu, C. H., Gao, F., Li, H. P., Xiang, H. C., Zhu, H., Zhou, B., He, W., Lin, C. Y., Pan, H. L., Wang, Q., & Li, M. (2018). Electroacupuncture Potentiates Cannabinoid Receptor-Mediated Descending Inhibitory Control in a Mouse Model of Knee Osteoarthritis. Frontiers in molecular neuroscience, 11, 112. https://doi.org/10.3389/fnmol.2018.00112
  37. Russo E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and clinical risk management, 4(1), 245–259. https://doi.org/10.2147/tcrm.s1928
  38. Zhang, M., Han, W., Hu, S., & Xu, H. (2013). Methylcobalamin: a potential vitamin of pain killer. Neural plasticity, 2013, 424651. https://doi.org/10.1155/2013/424651
  39. Ibid
  40. Xiong, W., (2012). Op cit.
  41. Russo E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and clinical risk management, 4(1), 245–259. https://doi.org/10.2147/tcrm.s1928
  42. Millar, S. A., Stone, N. L., Bellman, Z. D., Yates, A. S., England, T. J., & O’Sullivan, S. E. (2019). A systematic review of cannabidiol dosing in clinical populations. British journal of clinical pharmacology, 85(9), 1888–1900. https://doi.org/10.1111/bcp.14038
  43. Linares IM, Zuardi AW, Pereira LC, et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Braz J Psychiatry. 2019;41(1):9-14. doi:10.1590/1516-4446-2017-0015
  44. Ewing, L. E., Skinner, C. M., Quick, C. M., Kennon-McGill, S., McGill, M. R., Walker, L. A., ElSohly, M. A., Gurley, B. J., & Koturbash, I. (2019). Hepatotoxicity of a Cannabidiol-Rich Cannabis Extract in the Mouse Model. Molecules (Basel, Switzerland), 24(9), 1694. https://doi.org/10.3390/molecules24091694
  45. Nadulski T, Sporkert F, Schnelle M, et al. Simultaneous and sensitive analysis of THC, 11-OH-THC, THC-COOH, CBD, and CBN by GC-MS in plasma after oral application of small doses of THC and cannabis extract. J Anal Toxicol. 2005;29(8):782-789. doi:10.1093/jat/29.8.782
  46. Ibid
  47. Devinsky, O., Cilio, M. R., Cross, H., Fernandez-Ruiz, J., French, J., Hill, C., Katz, R., Di Marzo, V., Jutras-Aswad, D., Notcutt, W. G., Martinez-Orgado, J., Robson, P. J., Rohrback, B. G., Thiele, E., Whalley, B., & Friedman, D. (2014). Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia, 55(6), 791–802. https://doi.org/10.1111/epi.12631
  48. Shmerling, R.H., Can Vaping Damage Your Lungs? (2019)., Retrieved from https://www.health.harvard.edu/blog/can-vaping-damage-your-lungs-what-we-do-and-dont-know-2019090417734
  49. The 2018 United States Farm bill. Retrieved from https://www.usda.gov/farmbill
  50. Stuyt E. (2018). The Problem with the Current High Potency THC Marijuana from the Perspective of an Addiction Psychiatrist. Missouri medicine, 115(6), 482–486.
  51. DEA., Drug Fact Sheet., Retrieved from https://www.dea.gov/sites/default/files/2020-06/Marijuana-Cannabis-2020_0.pdf
  52. Liang, Y. C., (2004). Op cit.
  53. Pacher, P., (2006). Op cit.
  54. Jadoon,  (2017). Op cit.
  55. Liang, Y. C., (2004). Op cit
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