Introduction
Trigeminal neuralgia is a severe neuropathic pain disorder characterized by sudden, electric shock-like episodes of facial pain. It is classified into idiopathic, classical, and secondary forms. Diagnosis is primarily based on clinical history, as no definitive laboratory or diagnostic tests are currently available. When facial pain develops following trauma, including invasive dental procedures or fractures, the condition is often identified as painful post-traumatic trigeminal neuropathy. The condition can be debilitating and is frequently associated with sleep disturbances and psychological distress.1,2,3
Challenges in conventional management
Current treatment strategies primarily focus on pain control.
Commonly used medications include:
- Carbamazepine
- Phenytoin
- Gabapentin
- Clonazepam
These therapies may be associated with adverse effects such as:
- Drowsiness
- Nausea
- Dizziness
- Diplopia
- Ataxia
In cases where conservative treatment is insufficient, surgical interventions may be considered, including peripheral neurectomy, gasserian ganglion injection, root section of the nerve, and intramedullary trigeminal tractomy. Despite these options, long-term management remains challenging, highlighting the need for less invasive and more holistic therapeutic approaches.4
Ayurvedic understanding of trigeminal neuralgia
In Ayurveda, Aghata (injury) is described as one of the causative factors of Shiroroga (diseases of the head). Among the various disorders classified under Shiroroga, Anantavata exhibits clinical features that resemble trigeminal neuralgia.
Key features of Anantavata include:
- It is described as a Tridoshaja Vyadhi by Acharya Sushruta.
- Vitiated Doshas affect the Manya, a Sira Marma region.
- Severe pain may occur in the:
- Ghata (nape of the neck)
- Akshi (eyes)
- Bhru (eyebrows)
- Shankha Pradesha (temporal region)
- Associated manifestations may include:
- Kampa in the Ganda-parshva Pradesha
- Netraroga
- Hanugraha (spasm of the temporomandibular joint)
These features reflect the involvement of multiple anatomical regions of the head and face, consistent with the complex presentation of facial neuralgic pain.
Role of Nasya in management
Nasya is recommended in the management of Anantavata and Vataja Shiroroga. Since Anantavata is considered an Urdhwajatrugata Vikara, Nasya assumes particular importance because the nose is regarded as the gateway to the head.
The described therapeutic protocol included:
- Marsha Nasya using Anutaila
- Four drops administered in each nostril
- Treatment duration of eight days
- Facial massage with Tila Taila for 10–20 minutes
- Ksheera-bashpa Swedana using cow milk medicated with Balamoola before Nasya
The therapy was employed to alleviate Vata Dosha. The gentle warmth generated during Ksheera-bashpa Swedana helps soothe nerves, improve circulation, and support peripheral tissue health, while the medicated milk contributes nourishing and rejuvenating effects.
Conclusion
Trigeminal neuralgia and painful post-traumatic trigeminal neuropathy remain challenging pain disorders with limited definitive treatment options. From an Ayurvedic perspective, the condition may be understood through the framework of Anantavata, a form of Shiroroga involving Dosha imbalance and severe head and facial pain. Classical therapies such as Marsha Nasya with Anutaila, supported by Tila Taila massage and Ksheera-bashpa Swedana, represent a structured Ayurvedic approach aimed at addressing Vata-dominant pathology and supporting symptomatic relief.5
References:
1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629-808. doi:10.1177/0333102413485658. https://journals.sagepub.com/doi/10.1177/0333102413485658?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
2. Cruccu G, Finnerup NB, Jensen TS, et al. Trigeminal neuralgia: New classification and diagnostic grading for practice and research. Neurology. 2016;87(2):220-228. doi:10.1212/WNL.0000000000002840. https://pmc.ncbi.nlm.nih.gov/articles/PMC4940067/
3. Bandary DE, Lustofin SV, McLaren JR, Dillon JK. Surgical Management of Post-Traumatic Trigeminal Neuralgia - Case Report and Review of the Literature. J Oral Maxillofac Surg. 2022;80(2):214-222. doi:10.1016/j.joms.2021.08.266. https://linkinghub.elsevier.com/retrieve/pii/S0278-2391(21)01103-4
4. Hussain Z, Pathan S, Bibi F, Sultana S, Yasmeen R, Hanan S. Integrated pathology management of thyroid-linked sub-fertility: A multidisciplinary systematic approach in gynecology and Otorhinolaryngology. Rawal Med J. 2025;50(2):384-388. https://www.rmj.org.pk/fulltext/27-1747501315.pdf#page=126
5. Shamkuwar M, Nimbalkar K, Tripathi DM, Bhatia B, Manisha, Pal R. Panchakarma treatment for painful Post-Traumatic Trigeminal Neuropathy - A case report. J Ayurveda Integr Med. 2025;16(4):101168. doi:10.1016/j.jaim.2025.101168. https://pmc.ncbi.nlm.nih.gov/articles/PMC12270783/#sec6