TRIGEMINAL NEURALGIA

• Trigeminal neuralgia or tic douloureux is characterized by a sudden usually unilateral severe brief stabbing recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve
• Trigeminal neuralgia affects women more often than men, and it's more likely to occur in people who are older than 50
• Attacks can occur without provocation but are sometimes triggered by innocuous stimuli like chewing
• Classical trigeminal neuralgia (CTN): caused by neurovascular compression, most often by an aberrant loop of a neighbouring artery (usually the superior cerebellar artery)
• Secondary trigeminal neuralgia (STN): caused by a major underlying neurological disease, most frequently multiple sclerosis, a tumour at the cerebellopontine angle, or arteriovenous malformation
• Idiopathic trigeminal neuralgia (ITN): no identifiable cause (unremarkable findings on MRI and electrophysiological tests)

• The aetiology of TN and the underlying mechanisms of this condition is still poorly understood
• According to the International Classification of Headache Disorder-3, Classical TN is caused by Neurovascular compression, most frequently by the superior cerebellar artery of the trigeminal nerve roots into the pons. This compression usually results in the demyelination of nerve fibres
• Multiple Sclerosis
• Tumour
• Arteriovenous Malformation
• Facial Injury

Triggers:

• Sensory stimulation -Touch, certain head movements, talking, chewing, swallowing, shaving, brushing teeth, or even a cold draft
• In many, pain is generated spontaneously

• Pain is usually described as stabbing, paroxysmal, reminiscent of electric shock, or burning and is limited to the area innervated by one or more branches of the trigeminal nerve
• Sharp, pressing, crushing, exploding or shooting pain
• Unilateral facial pain followed by a burning ache
• Lasts several seconds (in rare cases, several minutes) and may occur up to 100 times per day
• Typically shoots from mouth to the angle of the jaw on the affected side
• Occurs either at rest or is triggered by movements such as chewing, talking, or touch (e.g., brushing teeth, washing face); becomes worse with stimulation
• Facial spasms may occur
• Psychological distress: ranging from dysphoria to severe depression with suicidal tendencies
• Usually progressive course

• Usually a clinical diagnosis is made
• Type of pain- sudden, shock-like and brief
• Location- Parts of the face innervated by the trigeminal nerve
• Triggers- light stimulation of cheeks, such as from eating, talking or even encountering a cool breeze

Neurological examination

• Touching and examining parts of the face can help to determine exactly where the pain is occurring and which branches of the trigeminal nerve may be affected
• The rapid spreading of pain, bilateral affliction, or involvement of other cranial nerves suggests a systemic cause
• MRI
• Blood work indicated to exclude collagen vascular diseases

• Anticonvulsant medicines—carbamazepine (most effective), oxcarbazepine, topiramate, clonazepam, phenytoin, lamotrigine, and valproic acid
• Surgical interventions (including SRS) Stereotactic Radiosurgery

Ayurvedic Treatment

Internal medicines

• Pathyashadanga Kashaya
• Astavarga Kashaya
• Dhanada nayanadi Kashaya
• Vaiswanara Choornam
• Panchakola Choornam
• Varanadi Gritha
• Sirasooladi vajra rasa
• Agnikumara rasa

Procedures

• Jaloukavacharana - forehead
• Virechana - Gandharvaeranda
• Nasya - Bringaraja Swarasa +Ajaksheera , Shadbindhu taila
• Ksheeradhuma - Vatahara drugs
• Karnapoorana - Dhanwanthara taila
• Thala – Rasnadi choorna + Nimbamruta eranda
• Lepa - Eranda leaves fried in Mahamasha taila + Saindhava (forehead)
• Shirodhara - Dhanwanthara taila , Balahatadi
• Shirovasti - Dhanwanthara taila, Uthama taila
• Sira moksha