Trigeminal Neuralgia: A case study on its management through Panchakarma

Trigeminal neuralgia (TN) is one of the most common forms of craniofacial pain characterized by sudden, brief, and excruciating facial pain attacks in one or more of the trigeminal nerve (V) branches [ophthalmic (V1), maxillary (V2), and mandibular (V3)], leading to a severe reduction in the quality of life of affected patients. The first-line pharmacological treatment for trigeminal neuralgia is the antiepileptic drugs like carbamazepine and oxcarbazepine. Some other drugs may be useful for pain control in TN. This case reports a twenty-nine-year-old male patient diagnosed with TN presented to the Panchakarma OPD, AYUSH wing, civil hospital, Ambala Cantt, Haryana, India. Patient has episodic, transient, paroxysmal, current like sensation on left cheek since seven years aggravated on exposure to wind and talking. There is no sensory or motor deficit. Paroxysms of pain appeared at the interval of every 1-2 hour every day lasting for 1-3 min. Magnetic resonance imaging (MRI) of brain reveals neurovascular contact at the cisternal segments of bilateral Vth cranial (trigeminal) nerves with vascular loops causing impingement of the left trigeminal nerve. The patient had a treatment history of seven years with allopathic medicine (Carbamazepine 200 mg 1tds, Mecobalamin 1500 mcg 1od and Pregabalin 75mg 1od). With no relief in signs and symptoms, he sought Ayurveda treatment due to recurrence and excessive pain. Ayurvedic interventions (Panchakarma) like Kukkutanda Sweda and Nasya with oral medications was given. Visual analogue scale (VAS) for pain, Hospital anxiety and depression scale (HADS), and Short Form 36 questionnaire (SF-36) for quality of life showed marked improvement after treatment and on follow-ups. Present case study highlights the usefulness of Ayurveda interventions, i.e., Oral medications, Kukkutanda Sweda and Nasya, in reducing the acute paroxysms of pain in TN and improving the quality of life of TN patients.