A Case of Trigeminal Neuralgia (TN)

The term Trigeminal Neuralgia (TN), has two words within it. Trigeminal nerve is one of the (twelve) cranial (head) nerves which has three divisions (ophthalmic, maxillary, and mandibular) supplying to the areas of upper eye-lid to the lower chin. Trigeminal nerve is the largest of twelve cranial nerves. All sensations from the face and mouth are covered by the Trigeminal nerve.

Neuralgia means pain. TN is a disorder of the Trigeminal nerve which presents as facial pain and headache. The pain is characteristically severe, intense, sharp, episodic, periodical , excruciating, stabbing and short lasting.

When the patient's Trigeminal nerve during an acute neuralgia phase was studied under electron microscope, it was revealed that the abnormality existed at the level of the inner nerve fibers called axons which carry nerve sensation, as well as the myelin (the nerve lining covering the nerve fibers). Due to the damage to such delicate parts, the nerve fiber behave like electrical wire with open ends, leading to electric shock like pain induced by touch or jerk.

Causes:

The exact cause of trigeminal neuralgia is not clearly understood but there are certain factors that can trigger the onset of trigeminal neuralgia. These are as follows:

• Compression: Abnormal compression of the nerve by an adjacent blood vessel in the brain
• Demyelination: Demyelination of the nerve that occurs as a result of nerve root injury
• Nerve damage: Physical damage to the nerve caused by dental or surgical procedures
• Genetic tendency: When we say genetic, it does not mean that every patient of TN has someone in the family having TN. Actually, there supposed to be a group of genes which are inherited and they evolve in certain way, when supported by other factors, leading to have TN. Only little understanding is achieved in this area, yet.
• Stress: stress is one of the triggering and aggravating factors if not primarily causative factor. It is a well-known fact that there is an inseparable bond between mind and body and that the psyche plays a vital role in maintaining health or causing diseases. It is a common experience in clinical practice that some patients report the onset of trigeminal neuralgia following major stressful events like divorce, death of close relatives, change of job, unhealthy family relationships, etc and this perception of patients that psychological stress can worsen trigeminal neuralgia has been supported in clinical studies. It is a common experience of many patients to have sudden pain when they are emotionally charged.
• Stress has been identified as an important cause in triggering as well as maintaining trigeminal neuralgia especially in the chronic cases. Stress can be in the form of:
• Prolonged anxiety due to any cause
• Grief, depression
• Suppressed anger/emotions
• Guilt
• Frustrations
• Despair
• Disappointments in life
• Nervous temperament
• Failures in business, etc.
• Frustration due to the unexplainable nature of the disease only makes the matters worse for the patient. Not all cases have a clear-cut cause and in many cases the cause may remain obscure i.e. idiopathic.
• Tumor and Multiple Sclerosis: Trigeminal Neuralgia pain caused due to tumor is called as secondary trigeminal neuralgia. Multiple sclerosis hardly contribute as the factor for causing Trigeminal Neuralgia.
• Immunological factors: Certain immunological parameters are found to be affecting TN in different ways. Immunity is now considered to be an important factor for pain and TN. Also, immunity is controlled and affected by emotional (stress) factors as well as genetic factors. Multiple Causes of Trigeminal Neuralgia: It has been observed that TN often is backed by more than one causes. As one can see, immunological causes are supported by stress and genetic factors; suggesting the causative factors work in a chain and they are interconnected.

Factors governing Pain and seizure threshold:

Episodes of trigeminal neuralgia increase when the patients pain threshold gets lowered. The pain threshold is affected by several known and unknown factors, some of them are:

• Stress
• Exposure of cold wind
• Brain trauma
• Inadequate sleep
• Poisoning with lead or other chemicals
• Hormonal fluctuation before and after the menses
• Hyperglycemia (High blood sugar)
• Certain antibiotics and anesthetic agents
• Ectopic action potential generation in the sensory root of the nerve may be responsible for the typical, episodic, electric, lancinating pain of TN.

Symptoms of Trigeminal Neuralgia (TN)

The Trigeminal Neuralgia pain is described as

• Lancinating pain (as if poked by thorns)
• Like electric shock (as if a live wire is left free inside of the face
• Stabbing pain
• Excruciating pain (as if a drilling machine is put on the certain part of face)
• Stitching pain
• Shooting pain
• Burning (as if fire)

The Trigeminal Neuralgia pain may appear suddenly, may last for a fraction of second or may be for a few minutes. The pain is periodic in nature. In rare cases it may last for a couple of hours, making the patients almost immobile, whereby he or she may not be able to do any other activity. One would tend to hold the affected part until pain settles. Some patients may feel frustrated and and may think of committing suicide out of hopelessness.

• Chewing and drinking
• The pain might typically get worse by following triggers:
• Brushing and gargling
• Touching the face
• Talking
• Kissing
• Slightest wind or draft of air
• Movement of eye lids or blinking

The Trigeminal Neuralgia is more common in the age group of 40 years plus. However, younger people as well as children may also present with TN. Very uncommon in children. The pain may get triggered either without any cause or by certain motions involving the facial muscles, such as washing face, brushing teeth, gargling, shaving, applying facial make-up, touching the face, blowing, kissing, etc. The pain may initiate in any of the parts supplied by the Trigeminal nerve. However, it may vary from patient to patient depending on which of the three divisions of the Trigeminal nerve is affected. It may present with pain in the head, upper face, cheeks, dental pain, pain in lips, side of tongue, chin, etc. In some cases the pain may present as dull aching, burning, and constant pain. Usually, one of the sides (right or left) is affected. The cause: The exact cause of TN remains a mystery. It is observed to run in families, indicating genetic predisposition. Detailed case study in our practice has shown history of prolonged stress in many cases. Prolonged underlying anxiety with the background of genetic diathesis may make one prone to this painful condition.

It is uncommon that TN will disappear spontaneously. However, there may be natural remissions or cyclical appearance of TN symptoms.

Diagnosis:

The diagnosis of Trigeminal Neuralgia is made clinically. In most cases the very description offered by the patients is diagnostic. There is no specific investigation or tests to diagnose Trigeminal Neuralgia. CT scan or an MRI is conducted only if some other pathology (tumor or multiple sclerosis) is suspected in the facial or brain areas which may have presented a confused clinical picture. However, as a rule, every patient with TN may be suggested to get an

MRI done to rule our any hidden tumor. It may also be noted that an MRI might suggest a blood vessel touching the Trigeminal nerve, as a cause for TN. However, it may be noted that all patients who have some blood vessel touching the Trigeminal nerve may not develop this disease.

At times, Trigeminal Neuralgia resembles certain other clinical conditions which have to be ruled out to establish the diagnosis of Trigeminal Neuralgia. The conditions which may present with symptoms similar to Trigeminal Neuralgia are: sinusitis, migraine headache, dental cavities, other forms of neuritis.

MANAGEMENT:

The conventional treatment for Trigeminal Neuralgia is partially effective. One always needs a supplementary or alternative treatment which is best offered by homeopathy. Homeopathic treatment works in the following manner:

• Relieving the intensity, frequency and duration of attacks
• Controlling the underlying process of nerve damage
• Enhancing pain threshold

Advantages of homeopathic treatment for Trigeminal Neuralgia:

• It is very effective even in resistant cases.
• It may be taken along with traditional medicines prescribed by neuro-physician.
• It is absolutely safe and non-toxic. It does not interfere with other medicines.
• It helps to reduce (and stop) the dose of conventional medicines for TN, once the improvement sets in. However, withdrawal of the medicine could be done slowly and under supervision of local physician
• It significantly helps to reduce the frequency and severity of TN attacks.

What is the duration of treatment for TN:

Trigeminal Neuralgia is a difficult disease. The treatment is long standing. Most patients experience improvement in about four weeks. Following factors determine the success of treatment:

1. Duration of TN: Recent cases respond faster
2. Current medication: Those who are on small dose of conventional medicine respond faster than those who are on very large dose. Fresh cases respond better.
3. Those who have nerve compression take longer time to respond
4. Patients who have simultaneous Multiple sclerosis are relatively difficult to treat

What is the limitation of Homeopathic treatment?

• It may not work in all the cases
• There may be a relapse after improvement

THE HOMEOPATHIC APPROACH TO TRIGEMINAL NEURALGIA:

Homeopathic approach to health and disease, in general, is more of a totalistic and holistic rather than looking any disease as a local disease. Having established that TN has genetic and psychosomatic links as causative factors, TN is looked at as a Constitutional disease and treated accordingly in homeopathy. However, certain medicine which has specific affinity on the trigeminal nerves and have an action to relieve painfulness, reducing pain threshold, are considered while selecting the treatment.

Every patients of TN is evaluated as an individual case and treated as such. While making the case analysis of TN patients, minutest of the details about the facial pain is noted carefully, as regard to the exact kind of sensation, the time of occurrence, the circumstances leading to the pain, the triggering factors, etc. Besides, a greater deal of emphasis is given to patients individual features such as eating habits, food preference, thermal attributes, sleep pattern. The study of the patient's mind and emotional spheres is conducted meaningfully, Besides, patients history of past diseases and that of the family diseases is understood to know the miasmatic background of the patients.

After putting all the vital information together, and fine evaluation process carried out, a individualist medicine is determined for the patient which treats the patient at a inner level, making healing at a deeper level, treating this chronic disease. The homeopathic medicine thus administered, reduces the frequency of the TN episodes, making them less intense, and eventually leading to a remission. The success rate observed is over 70% at our center.

SOME TIPS TO AVOID PAINFUL ATTACKS:

• Avoid exposure to wind and draft of cold air
• Avoid (mental and physical) stress such as anxiety, lack of sleep, long drives, etc.
• Avoid low room temperature for throughout the night, it might aggravate pain at night or on waking up
• Identify some trigger factors such as cold water, gargling, certain facial movements while eating or shaving, etc. and avoid them
• Avoid missing doses of medicines
• Avoid eating hard food articles
• Learn to avoid sudden jerky movements, turning neck while driving, etc.
• Maintain excellent oral hygiene to avoid dental carries

Homeopathic treatment for Trigeminal Neuralgia is safe and free from adverse effects.

Most patients who have been taking the conventional medicines for Trigeminal treatment, at one point look for stopping them as the medicines often induce a variety of side-effects such as lethargy, loss of memory, weakness of bones (osteoporosis), giddiness, low energy, etc.

After starting homeopathic medicines, it is often possible to reduce or stop the need for the conventional medicines, depending on the extent of TN as well as the drug dependency. We are working on a protocol which has helped many to achieve it. However, it may not be possible in all the cases. Here are some guidelines on how to do it.

First of all, the dose reduction after starting the homeopathic medicine is advised to be done only under care of a local Neuro-physician or family physician who is familiar with your case. It may be noted that abrupt reduction of dose of the conventional medicine may lead to severe relapse which may call for additional dose. Please note that the writer of these instructions or the doctors connected with this website do not take any responsibility whatsoever if the patient experiences any after-effects due to reduction of the dose.

Steps for Reducing Conventional Medicines

• Patient must initially continue with his conventional medicines even after starting homeopathic medicines and should not stop it without the advice of his doctor.
• On seeing improvement in the pain after starting homeopathic medicines, the patient can gradually taper down the dose of conventional medicines over a period of time.
• Under no circumstances should the patient stop conventional treatment without medical advice since this may cause rebound increase in the severity of the complaints.
• When the patient notices about 25% improvement in his trigeminal neuralgia (frequency, duration and severity of the pain) after starting homeopathic treatment and this improvement is sustained, he can reduce the dosage of the conventional medicine by about 20%. This reduced dosage must be maintained for at least 2 months before reducing the dose further.
• In case there is rebound increase in the complaints after reducing conventional medicines, the patient must revert back to the original dose of the medicine.
• Once the improvement is progressive and sustained subsequently, further reduction of the dose may be done. Please remember to avoid hurry or over enthusiasm in the tapering of the dose. It may also be noted that in severe or resistant cases, tapering of the dose may not be successful.
• Any reduction in the dose of the conventional medicines must be done only under the supervision of the treating Neuro-physician and the same should be informed to us.

Homoeopathic Therapeutics of TN:

1. Colocynthis
   A patient comes to the physician with left sided face-ache with H/O Exposure to dry cold or damp weather or there may be history of emotional upset like anger, indignation chagrin or grief. Pain with numbness and chilliness extending to left ear and lower jaw. Agg. Left side, motion, touch, anger, 5 p. m . Amel. Rest, warmth and pressure . In Trigeminal neuralgia, better by lying with head bent forward.
2. Nux Vomica
   Nux Vomica patient is a typical busy person used to modern city life with mental stress and strain, sedentary occupation with loss of sleep and high living. Such a person suffers initially from a dyspepsia which is characterized by loss of appetite, flatulence, constipation with ineffectual urge for stool and sometimes the patient feels - If I could vomit out I would feel so much better. He is a chilly and irritable patient and is hypersensitive who has developed left sided Trigeminal neuralgia as a reflex symptom due to the above mentioned dyspepsia, after exposure to dry cold wind. There may be H/O alcoholism. Agg. In the evening and night, cold, anger. Amel. Strong pressure and warmth. O/E Frowning look, posterior coating of tongue. Hypersensitiveness of the affected part and tenderness of left iliac fossa.
3. Spigelia Anthelmia
   It is a very important remedy for facial neuralgia and migraine. Left side is commonly affected but it is also indicated for rightsided trigeminal neuralgia. Burning needle like pain extends to eye and neck. Pain comes at REGULAR INTERVAL. Agg. Touch, jar , stormy weather, mastication. Amel. Pressure , lying on right side with head high.
4. Verbascum Thapsus
   so indicated for rightsided trigeminal neuralgia. Burning needle like pain extends to eye and neck. Pain comes at REGULAR INTERVAL. Agg. Touch, jar , stormy weather, mastication. Amel. Pressure , lying on right side with head high.
5. Aconitum Napellus
   It is useful in the acute stage of the disease and also useful in acute stage of the chronic disease. owever, in the later condition it will only relieve - may not cure. xposure to dry cold wind . Suddenness . Night aggravation and fear of death are very important symptoms inselecting this remedy. Agg. Touch, jar, night, dry cold wind. O/E Redness and dry hot skin, tenderness on touch.
6. Chamomilla
   The most characteristic symptom of this remedy is the pain which is out ofproportion to underlying pathology. Hypersensitive patient. Unbearable pain make the patient irritable and snapish. Inclined to bend head backwards. NUMBNESS WITH PAIN. HOT PATIENT . SLEEPLESS. Agg. Warm drinks, coffee , night, anger. Amel. Warm wet weather, rocking . Incidently, it is also a useful remedy for toothache. O/E One cheek red another pale.
7. Belladonna
   Like Aconite it is also useful in the acute stage of the disease. It follows Aconite well. Patient comes with right sided facial neuralgia with twitching ofthe facial muscles. Shooting pain. Agg. Touch, jar, light . Amel.Clenching teeth tightly. O/E Flushing of the affected side, skin dry hot, tender, throbbing carotids,head hot and extremities cold. Pupils dilated. Quite often Belladonna is the acute of CALC-CARB. in chronic affection.
8. Sanguinaria Canadensis
   Right sided neuralgia. Burning and heat of face. Supra-orbital neuralgia associated with nausea . Agg. Sun, periodically . Amel. Cold.