Management of Classical Trigeminal Neuralgia with Ayurvedic Interventions: A Case Report

Abstract

Background: Classical trigeminal neuralgia (CTN) is a chronic neuropathic pain disorder characterized by severe, paroxysmal facial pain attributable to neurovascular compression of the trigeminal nerve. Conventional treatments often provide incomplete relief or lead to recurrence, prompting exploration of alternative systems such as Ayurveda. Case Presentation: A 50-year-old female patient presented with a two-year history of intermittent, excruciating pain on the right side of the face, affecting the upper lip, cheek, and chin. Pain paroxysms occurred every 1–2 hours, lasting 1–2 minutes each. Magnetic resonance imaging (MRI) confirmed right-sided classical trigeminal neuralgia due to vascular loop indentation on the cisternal segment of the trigeminal nerve. The patient had received allopathic pharmacotherapy for two years with recurrent episodes and inadequate control, leading her to seek Ayurvedic management. Interventions: The patient underwent a three-month course of Ayurvedic treatments, including oral medications, Nasya (nasal instillation), Kavalagraha (oral retention), and Gandusha (oral gargling/holding). Outcomes: Marked improvement was observed post-treatment, as evidenced by substantial reductions in pain intensity on the Visual Analogue Scale (VAS) from 8 to 2 and in anxiety and depression scores on the Hospital Anxiety and Depression Scale (HADS). Improvement in all the domains of SF-36 was observed, with a total percentage improvement from 11% to 83%. Conclusion: This case illustrates the potential utility of integrated Ayurvedic interventions i.e. oral medications combined with Nasya, Kavalagraha, and Gandusha in alleviating acute paroxysmal pain episodes, mitigating associated psychological distress, and enhancing quality of life in patients with classical trigeminal neuralgia. These observations support further clinical studies to validate Ayurvedic approaches in managing refractory CTN..