Trigeminal Neuralgia

Trigeminal Neuralgia: Introduction

The Trigeminal Neuralgia has two words within it.The first one is Trigeminal nerve largest of twelve cranial nerves which has three divisions i.e. ophthalmic, maxillary, and mandibular supplying to the areas of upper eye-lid to the lower chin. All the sensations from face and mouth are covered by the Trigeminal nerve.
The second one is Neuralgia which means pain. TN is a disorder of the Trigeminal nerve which presents as facial pain and headache. The pain characteristically severe, intense, sharp, episodic, periodical, excruciating, stabbing and short lasting.
TN is also known as tic douloureux.

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.

What causes Trigeminal Neuralgia?

The causes of TN are explained in detail on a separate page. In short, it has been increasingly proved and understood that most cases of TN have demyelination of the sensory nerve fibers of the Trigeminal Nerve, either in the nerve root or (rarely) the brain stem. Demyelination means an erosion of the nerve sheath, which leads to the exposure of the nerve fibers. The exposed nerve fibers often get compressed or irritated by blood vessels (pulsating arteries or veins), which lead to painful episodes of Trigeminal Neuralgia due to misfiring of the nerve..

Trigeminal Neuralgia Causes: Factors Causing Trigeminal Neuralgia

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

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01 Compression:

Abnormal compression of the nerve by an adjacent blood vessel in the brain

02 Demyelination:

Demyelination of the nerve that occurs as a result of nerve root injury

03 Nerve damage:

Physical damage to the nerve caused by dental or surgical procedures

04 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.

05 Stress & Trigeminal Neuralgia

Psychological 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.

06 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.

07 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.

Homeopathic treatment for Trigeminal Neuralgia: Homeopathy addresses multiple causes and factors while deciding on the treatment.

Symptoms of Trigeminal Neuralgia (TN)

As Trigeminal Neuralgia is typically described by the patients as episodes of extremely severe pain. TN is probably the most painful condition known to the human race.

The Trigeminal Neuralgia pain is described as:
a Lancinating pain (as if poked by thorns)
b Like electric shock (as if a live wire is left free inside of the face)
c Stabbing pain
d Excruciating pain (as if a drilling machine is put on the certain part of face)
e Stitching pain
f Shooting pain
g 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.

The pain might typically get worse by following triggers:
a Chewing and drinking
b Brushing and gargling
c Touching the face
d Talking
e Kissing
f Slightest wind or draft of air
g 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, 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.

Trigeminal Neuralgia 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.

Homeopathic Treatment for Trigeminal Neuralgia

The conventional treatment for Trigeminal Neuralgia is partially effective. One always needs a supplementary or alternative treatment which is best offered by homeopathy.
Homeopathy works extremely well in most cases of TN. The results have been scientifically documented.

Homeopathic treatment works in the following manner:

1. Relieving the intensity,
2. frequency and duration of attacks
3. Controlling the underlying process of nerve damage
4. Enhancing pain threshold

Advantages of homeopathic treatment for Trigeminal Neuralgia:

1. It is very effective even in resistant cases.
2. It may be taken along with traditional medicines prescribed by neuro-physician.
3. It is absolutely safe and non-toxic.
4. 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
5. It significantly helps to reduce the frequency and severity of TN attacks.

Tips for Trigeminal Neuralgia Pain Management

Some tips to avoid painful attacks:

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

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

1. Patient must initially continue with his conventional medicines even after starting homeopathic medicines and should not stop it without the advice of his doctor.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.

Carbamazepine adverse effects in Trigeminal Neuralgia

For Trigeminal Neuralgia treatment, conventional doctors would prescribe Carbamazepine. Carbamazepine is actually an anticonvulsant (epilepsy) which is found to be effective treatment in many cases as long as taken for a long period. Carbamazepine may not be as effective for Atypical Trigeminal Neuralgia. Common trade names are Tegretol, Mazetol, etc.

Side effects of Carbamazepine

1. Overdose of carbamazepine could prove fatal, deaths have been reported rarely, with very large doses, without supervision of a doctor.
2. Early side effects are drowsiness, fatigue, dizziness, or nausea.
3. Memory loss and a sense of exhaustion are observed commonly.
4. Weight gain is a major and common side effect.
5. Osteoporosis (loss of calcium) is a common adverse effect demanding extra dose of calcium supplement.
6. Nystagmus (side to side movement of the eye ball.)
7. Damage in vision is a major long term side effect.
8. Altered thought process is a significant side effect in some patients.
9. Skin rash and lowered blood pressure may prove serious problem in some patients, calling for urgent medical attention.
10. Low level of sodium (Hyponatremia) is a serious side effect on long term use.
11. Hematologic (blood related), hepatic (liver related), cardiovascular (heart related) and dermatologic reactions, which require discontinuation of therapy.
12. Psychiatric symptoms likes hallucinations (visual or acoustic), depression, sometimes, talkativeness, agitation, loss of appetite, restlessness, aggressive behavior, confusion, activation of psychosis may be observed.
Homeopathic treatment for Trigeminal Neuralgia is safe and free from adverse effects.

Best Homeopathic Doctor & Treatment for Trigeminal Neuralgia in India. Just Call at +91 7087462000 and make an appointment with Dr. Singhal Homeo, and get Homeopathic Treatment.