ABSTRACT
Trigeminal neuralgia causes severe facial pain, affecting daily life and leading to anxiety and depression. The latest classification differentiates between primary and secondary forms. Treatments, including anticonvulsants and surgery, have mixed results. Ayurveda links this condition to an excess of Vata dosha in the cranial nerves.
Aim and Objectives:
To discover the potential of Ayurveda in the acute management of Type 1 trigeminal neuralgia.
Material and Methods:
A 41-year-old woman with intermittent pricking pain and tingling in the right lower jaw was diagnosed with Type 1 trigeminal neuralgia. She received Shamana and Shodhan Chikitsa as per Ayurvedic principles for 15 days.
Observation and Results:
Pain and shock-like sensations decreased, reducing the social fear of pain and improving quality of life. Transient numbness occurred early.
KEYWORDS: Anantavata, ayurveda, quality of life, trigeminal neuralgia
INTRODUCTION
Trigeminal neuralgia is a neuropathic pain disorder that causes electric shock-like pain in the branches of the trigeminal nerve, often triggered by speaking or eating, and profoundly affects daily life. It is categorized as persistent facial pain, with secondary forms linked to multiple sclerosis, trauma, tumors, or post-herpetic neuralgia.[1,2] A trigeminal neuralgic attack can last from less than 1 s to several minutes, with brief post-attack refractory periods.[3] Patients with trigeminal neuralgia experience pain-free intervals between attacks. Treatments include anticonvulsants, muscle relaxants, neuroleptics, and advanced interventions for resistant cases, though they carry associated risks. Ayurveda links this condition to “Anantvata,” which is characterized by chronic pain due to an imbalance of Vata.[4] Imbalance of vata, causing disorders usually requires a treatment described under Vatavyadhichikitsa in ancient texts.[5] A predominance of Vata defines Anantvata and requires treatment aimed at reducing elevated Vata in the head.
CASE REPORT
A 41-year-old housewife from Padegao, Wardha, India, has experienced intermittent acute right jaw pain and chin tingling for 2.3 years, worsened by touch, especially in the mornings and evenings. Despite 1.5 years of treatment with carbamazepine 800 mg/day, pain relief was minimal, with persistent nausea and mild fatigue. There is no significant family history, although a maternal history of Vata disorder is present. The patient is anxious about the potential recurrence of pain in social situations.
Clinical findings
General Examination: No significant physical changes were noted according to the Ayurveda Astavidha Pariksha. The patient appeared distressed based on modern vital signs. Systemic Examination: Normal cardiovascular and respiratory systems. The central nervous system assessment showed intermittent right lower jaw pain and numbness without focal deficits.
Ayurvedic Dashavidha Pariksha: The patient’s Prakriti was Vata Pradhana-kapha, and the Vikruti was Dosha-Vatapradhan. Satwa, Samhana, Pramana, Vyayamshakti, and Vaya were Madhyam. Sara was Rasa Majja, Satmya was Sarva rasa, and Aharshakti was Avara.
History of present illness
The patient, initially asymptomatic, developed right chin pain and tingling. Carbamazepine treatment initially reduced the pain but caused side effects, leading to its discontinuation. Four months later, the pain worsened, prompting further evaluation at Kaya O.P.D. No. 30.
Diagnostic assessment
The patient was diagnosed with Type I trigeminal neuralgia. An MRI showed no compressions, which was consistent with the patient’s symptoms and neurological examination.
Diagnostic challenges
According to Ayurveda, this condition is correlated with Anantvata.
Diagnosis (including other diagnoses considered)
Figure 1 The patient’s constitution was evaluated as Vata-Pitta, leading to recommendations for a 15-day regimen of Shodhan (purification therapy) and Shaman (pacifying therapy).
Figure 1.
Pathogenesis to diagnose the condition (Samprapti)
Therapeutic intervention
The patient’s constitution, assessed as Vata-Pitta, prompted a 15-day regimen combining Shodhan (purification therapy) and Shaman (pacifying therapy) for holistic management.
Pacifying treatment (shamana chikitsa): 15 days
Palsineuron: One tablet T.D.S. with lukewarm water before meals.
Dhanvantaram 101: One tablet B.D. with lukewarm water after meals.
Aadarikadi Kashayam: 15 ml T.D.S.
Avipattikara Churna: 5 gm H.S. with lukewarm water before meals.
Shodhan therapy (purificatory therapy): 15 days
Shirodhara: 750 ml of brahmi oil and 250 ml of til oil applied.
Nasya: Incremental administration of Panchaindriyavardhan Taila, 4–8 drops per nostril, with daily dosage adjustments.
Trisnehadharana: Application of Shatadhauta Ghrit on the head and face for 30 min, twice daily, using gauze pads.
Follow-up and outcome
Follow-up on days 7, 15, and 30 showed significant improvement in pain and numbness [Table 1], with no relapse of trigeminal neuralgia.
Table 1.
Follow-ups and outcomes
| Parameters | Symptoms Gradation score | |||
|---|---|---|---|---|
|
| ||||
| Day 1 | Day 7 | Day 15 | Day 30 | |
| Facial electric shock-like Pain | +++ | ++ | + | 0 |
| Numbness | +++ | ++ | + | 0 |
| Pain Frequency/Day | 2 | 1 | 0 | 0 |
| Subjective fear of recurrent attacks | +++ | ++ | + | 0 |
Subjective parameter
Pain- Barrow Neurological Institute (BNI) pain intensity scale score Numbness- Barrow Neurological Institute facial hypesthesia scale.[6]
DISCUSSION
Ayurvedic treatment for trigeminal neuralgia focuses on rebalancing Vata dosha to alleviate symptoms. Palsineuron capsules address neuromuscular disorders by enhancing metabolic functions, improving blood flow, and prompting the repair of nerves and blood vessels, supporting holistic management.[7] Panchaindriyavardhan oil used in Nasya stimulates the limbic system, aiding in the expulsion of vitiated Doshas. It provides analgesic, anti-inflammatory, and nervine benefits for trigeminal neuralgia.[8] Cap. Dhanwantaram 101, an Ayurvedic remedy, contains ingredients such as Sida cordifolia (Bala) for pain relief, Dashamool for pain and inflammation, Triphala for its antioxidant benefits, and Vacha (Acorus calamus) for nerve pain. These components work together to alleviate trigeminal neuralgia symptoms by reducing inflammation and supporting nerve health.[9,10,11,12] Aadarikadi Kashayam, an anti-inflammatory and analgesic, complements conventional treatments for trigeminal neuralgia, potentially improving symptoms and quality of life.[13,14] Shirodhara, using warm herbal oils like Bramhi Taila and Til Taila, promotes relaxation, reduces stress, and aids in managing trigeminal neuralgia through neuroprotective and anti-inflammatory effects.[15] Trisnehadharana with Shatadhauta ghrita (medicated ghee) offers localized relief by reducing pain perception and inflammation.[16] The treatment aims to achieve Vatanulomana, enhance Agnideepana, facilitate Sulaprasamana and Vedanasthapana, improve Raktprasadana, emphasize Brimhana Chikitsa, and implement Rasayana to enhance overall health and prevent recurrence of vitiated doshas.
CONCLUSION
Ananta Vata in Ayurveda addresses chronic Vayu-related diseases that are aggravated by imbalances in Rakta. Restoring balance through practices such as Dinacharya and Sadvrittas improves health and vitality.
Patient perspective
The patient experienced increased comfort and reduced distress from recurrent facial pain, especially in the lower right jaw. The treatment significantly improved the patients’s quality of life.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
We declare that this manuscript is original, has not been published previously, and is not currently under consideration for publication elsewhere.
Funding Statement
Nil.
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