Trigeminal Neuralgia

Trigeminal neuralgia is severe paroxysmal, sudden lancinating facial pain due to a disorder of the 5th cranial nerve.

Trigeminal neuralgia affects mainly adults, especially the elderly.

This condition causes facial pain and it is the most frequently occurring of all the nerve pain disorders. The pain, which comes and goes, feels like bursts of sharp, stabbing, electric-shocks. This pain can last from a few seconds to a few minutes.

People with trigeminal neuralgia become plagued by intermittent severe pain that interferes with common daily activities such as eating and sleep. People often call trigeminal neuralgia "tic douloureux" because of a characteristic muscle spasm that accompanies the pain.

The pain comes from one or more branches of the trigeminal nerve-the major carrier of sensory information from the face to the brain.

There are 3 branches of the trigeminal nerve: the ophthalmic, maxillary, and mandibular.

The pain of trigeminal neuralgia occurs almost exclusively in the maxillary and mandibular divisions.

People affected with trigeminal neuralgia commonly feel pain in the maxillary nerve, which runs along your

cheekbone,

most of your nose, Upper lip and upper teeth.

Next most commonly affected is the mandibular nerve, affecting your

lower cheek,

Lower lip and jaw.

In almost all cases (97%), pain will be restricted to one side of your face.

Trigeminal neuralgia most frequently affects women older than 50 years. The disease occurs rarely in those younger than 30 years.

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EtiologyTrigeminal neuralgia is usually caused by an intracranial artery (eg, anterior inferior cerebellar artery, ectatic basilar artery) or, less often, a venous loop that compresses the 5th cranial (trigeminal) nerve at its root entry zone into the brain stem. Other less common causes include compression by a tumor and occasionally a multiple sclerosis plaque at the root entry zone, but these are distinguished usually by accompanying sensory and other deficits.

Symptoms and Signs

Occasional twinges of mild pain

Episodes of severe, shooting or jabbing pain that may feel like an electric shock

Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking and brushing teeth

Bouts of pain lasting from a few seconds to several seconds

Episodes of several attacks lasting days, weeks, months or longer —some people have periods when they experience no pain

Pain in areas supplied by the trigeminal nerve (nerve branches), including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead

Pain affecting one side of your face at a time

Pain focused in one spot or spread in a wider pattern

Attacks becoming more frequent and intense over time

Sleeping on that side of the face is often intolerable.

Diagnosis

Clinical evaluation

Symptoms are almost pathognomonic. Thus, some other disorders that cause facial pain can be differentiated clinically: Migraine, which may cause atypical facial pain, is differentiated by pain that is more prolonged and often throbbing.

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In Ayurvedic perspective,

Here, vata increases in kapha sthanam. The drugs that possess properties such as ushna, snigdha and madhura rasa dravyas are selected.

Kashayam

Ashtavargam – 50 ml twice daily before food (Sahasra Yogam) Badradarvadi – 50 ml twice daily before food (A.H.Sutra sthanam Ganam) Dhanadanayanadi – 50 ml twice daily before food (Sahasra Yogam) Rasonadi kashayam – 60 ml twice daily before food (Sahasra Yogam)

In later phases,

Prasaranyadi kashayam – 60 ml twice daily before food (Sahasra Yogam)

Cūŗņam

Aśvagandha cūŗņam – 1 teaspoon with milk at night. (B.Prakasha) Narasimha cūŗņam – 1 teaspoon bd with milk after food (Chakradatta) Kapikachu choornam – 1 teaspoon with milk at night after food

Vati

Lashunadi vati – 2 tablet twice daily after food (Vaidyajivanam)

Rasa ouşadi

Chaņda mārutham – 1 pinch twice daily with honey (3 times a week) Bruhatvata chintamani ras– 125 mg bd after food (Bhaishajya Ratnavali) Vata gajankusha ras – 125 mg bd after food (Bhaishajya Ratnavali) Svarna malini vasantha ras – 250 – 500 mg bd after food

Ghŗtam

Lashunadi ghŗtam – 1 teaspoon with milk at night. (A.H. chikitsa sthana)

Thailam

Sahacharadi – 1 teaspoon with milk at night after food (A.H. Vata vyadhi) Karpas – 1 teaspoon with milk at night after food Prasaranyadi – 1 teaspoon with milk at night after food Vatashini – 1 teaspoon with milk at night after food

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Thalam

Rāsnādi choornam with Nimbamrutha erandam

Lepam

Masha lepam (powder mixed with egg white or milk)

Śiro vasti

Asanavilvādi tailam (S.Y) Elādi tailam Karpasasthyadi thailam (S.Y)

Nasyam

Karpāsasyādi tailam – 2 drops in each nostril (S.Y) Śuņţi tailam – 2 drops in each nostril Ksheerabala (A.H.) – 2 drops in each nostril

Ksheera dhumam

Bala ksheera dhumam Dashamoola ksheera dhumam

Kavalam

Arimedadi thailam with Dhanwantharam kashayam

Rasayanam

Lashuna rasyanam (Ashtanga Sangraha) Siddhamakaradwajam – 1 tablet twice daily Bruhat vatachintamani ras – 1 tablet twice daily (Bhaishajya Ratnavali)

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