Description

• 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)

Types

• 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

Investigation

• 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

Treatments

• 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

Department

Salakya - ENT