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Trigeminal neuralgia (TN, or TGN), also known as prosopalgia, or Fothergill’s disease is a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve
Trigeminal neuralgia is inflammation of the trigeminal nerve, causing intense facial pain. It is also known as tic douloureax because the intense pain can cause patients to contort their face into a grimace and cause the head to move away from the pain. The obvious movement is known as a tic.
- 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, 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
Pathology of Trigeminal Neuralgia
The fifth cranial nerve, i.e., Trigeminal nerve, is named after its three branches – Ophthalmic nerve, Maxillary nerve and Mandibular nerve. Altogether, they provide the brain with all the information about sensations felt in the face.
- Ophthalmic nerve carries sensation to brain from eye, upper eyelids and forehead
- Maxillary nerve carries sensations from lower eyelid, nose, cheek and upper lip
- Mandibular nerve carries sensations from lower lip, jaw and mucous membrane of mouth and throat. It also helps in actions like biting, chewing, and swallowing.
Any flickering or disturbance in concerned branch (branches) may cause pain or altered sensation or loss of sensation in the respective area. Usually triggers cause violent pain and twitching.
Causes of Trigeminal Neuralgia
Most often, the cause of trigeminal neuralgia is idiopathic, meaning the cause is not known. There are some instances when the nerve can be compressed by nearby blood vessels, aneurysms, or tumors.
There are inflammatory causes of trigeminal neuralgia because of systemic diseases including multiple sclerosis, sarcoidosis, and Lyme disease. There also is an association with collagen vascular diseases including scleroderma and systemic lupus erythematosus.
Types of Trigeminal Neuralgia
(1)The typical or “classic” form of the disorder (called “Type 1” or TN1) causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episode. These attacks can occur in quick succession, in volleys lasting as long as two hours.
(2) The “atypical” form of the disorder (called “Type 2” or TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than Type 1.
Both forms of pain may occur in the same person, sometimes at the same time. The intensity of pain can be physically and mentally incapacitating.
To treat trigeminal neuralgia, your doctor usually will prescribe medications to lessen or block the pain signals sent to your brain.
- Anticonvulsants- such as carbamazepine (Tegretol, Carbatrol, others) for trigeminal neuralgia, and it’s been shown to be effective in treating the condition. Other anticonvulsant drugs that may be used to treat trigeminal neuralgia include oxcarbazepine (Trileptal).
- Antispasmodic agents. Muscle-relaxing agents such as baclofen (Gablofen, Lioresal) may be used alone or in combination with carbamazepine.
In trigeminal neuralgia surgery, surgeons’ goals are to stop the blood vessel from compressing the trigeminal nerve or to damage the trigeminal nerve to keep it from malfunctioning..
Surgical options for trigeminal neuralgia include:
- Microvascular decompression.
- Gamma Knife radiosurgery.
- Other procedures may be used to treat trigeminal neuralgia, such as a rhizotomy.
- Balloon compression.
- Radiofrequency thermal lesioning.
Spigelia markedly affects the nervous system, particularly the Trigeminal nerve. It positively influences the heart, eyes and the head. A few of its characteristic symptoms are as follows:
Stabbing pains which make the patient shudder. Pains come suddenly and go suddenly.
Violent tearing, burning, jerking pains in individuals who are very sensitive to touch.
Syphillinum is a deep acting, polycrest remedy affecting multiple systems of the body.
It positively influences the mind, sensorium, skin, gastrointestinal tract, genito-urinary system, nerves, bones, etc. It is a very helpful remedy to combat hereditary syphilitic tendencies in patients.
Syphillinum is frequently used in the homeopathic treatment of trigeminal neuralgia. Severe, violent, sharp pains characterize this remedy.
It is one of the most frequently used medicines for trigeminal neuralgia.
(4) Cinchona officinalis (China):
China is frequently used in the treatment of neuralgic pains
There is marked debility in the patient due to the loss of vital fluids. The patient is weak and nervous and oversensitive to pain. Periodicity of the complaints is marked with complaints recurring every alternate day and symptoms getting invariably worse at night. Pains are worse from touch, draft of air and from jerky movements.
Predominantly affects the nervous system and the female reproductive system. It has special affinity for Trigeminal, vagus and sensory nerves.
Violent, cramping, numbing pains, later progressing to spasms.
Painful tremors and spasms. Coldness and numbness of the face, sensation as if squeezed in a vise. Oversensitive state of mind and nerves. Pains come gradually and go gradually.
An important striking feature of this remedy is neuralgic pains occurring periodically at the same time everyday. Neuralgia affecting the first division of the trigeminal nerve causing pains across the forehead and around the eyes. Intense pain that is worse in open air and worse after sleep. Periodicity of complaints is the hallmark of this wonderful drug used for TN.
(7) Sanguinaria Canadensis:
It is a remedy with predominant affinity for the right side. Facial neuralgia on the right side which is better by kneeling and by pressing head against floor. Facial pain on the right side that extends in all directions and is accompanied with redness and burning of the cheeks.
(8) Aranea diadema:
This is a wonderful remedy for Trigeminal neuralgia and has been found very useful in many cases of TN. Patient gets neuralgic pains which are worse in damp climate and worse from cold weather. The pain gets worse around afternoon and at midnight and is better by pressure.
The pain returns periodically i.e. the neuralgic attacks occur at the same hour every day, every other day, week, month or at regular intervals. Violent, sudden pains like electric shocks.
Pain in the right trigeminal nerve from periphery inwards. Sudden violent pain in teeth at night immediately after lying down. Sensation as of enormous enlargement or of numbness of parts.
It is one of the very good remedies for Trigeminal neuralgia. It is commonly used for colds and catarrhs, spasmodic effects and neuralgic pains.
It is a specific remedy for Neuralgia of the Inferior branch of the Trigeminal Nerve.
Patients suffer from pains that are benumbing, pinching, pressing, stitching, squeezing, cramping. Neuralgia affecting left side of face with lacrymation.
(10) Magnesia phosphorica:
It is one the very good homeopathic remedies used to control pain. Few of its common indications in trigeminal neuralgia are:
Supra or infra-orbital facial neuralgia, especially right-sided neuralgic pains. Pain occurs in unbearable paroxysms, lightening-like pains, driving the patient to frenzy. Pains are cramping, shooting, spasmodic, sharp, cutting, stabbing; they come and go suddenly.
Patient has great dread of cold air, of uncovering, or touching the affected part. Neuralgic pains relieved by warmth.