Trigeminal neuralgia (TN), also called tic douloureux, is pain in the trigeminal nerve, which carries sensation from the face to the brain. The pain is felt in the areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips or less often the eye and forehead. This pain may range from occasional twinges of mild pain to episodes of severe shooting or jabbing pain. This condition is usually caused due to the following: pressure on the nerve by an artery or vein; as a result of ageing; pressure due to a tumor; damage to the nerve due to multiple sclerosis and other diseases and unknown causes. The pain can be triggered by simple things like shaving, stroking the face, eating, drinking, brushing of teeth, talking, putting on make-up, encountering a breeze or smiling.

The Ayurvedic treatment of TN is aimed at controlling the pain and treating the cause, if known. For symptomatic relief of pain, medicines like Yograj-Guggulu, Kaishor-Guggulu, Trayodashang-Guggulu, Panch-Tikta-Ghrut-Guggulu, Tapyadi-Loh, Ekang-Veer-Ras, Maha-Vat-Vidhwans-Ras, Vat-Gajankush-Ras, Vish-Tinduk-Vati and Agnitundi-Vati are used. Herbal medicines used are: Nirgundi (Vitex negundo), Dashmool (Ten roots), Chitrak (Plumbago zeylanica), Kuchla (Strychnos nuxvomica), Guggulu (Commiphora mukul), Punarnava (Boerhaavia diffusa), Tagar (Valeriana wallichii), Shalparni (Desmodium gangeticum), Prushnaparni (Uraria picta), Vishwa (Zinziber officinalis), Marich (Piper nigrum), Khurasani-Ova (Hyoscyamus niger), Jatamansi (Nardostachys jatamansi), Ashwagandha (Withania somnifera), Yashtimadhuk (Glycerrhiza glabra), Sarpagandha (Rauwolfia serpentina) and Jayphal (Myristica fragrans).

Patients with known neuritis or neuralgia can be treated with high doses of Kaishor-Guggulu, Tapyadi-Loh and Ekang-Veer-Ras. With evidence of pressure on the nerve due to an artery or vein, medicines like Maha-Vaat-Vidhwans, Jatamansi and Sarpagandha can be used to reduce the sensitivity of the nerve. A tumor may be treated either surgically or with medicines like Arogya-Vardhini, Kanchnaar-Guggulu and Triphala-Guggulu. If there is known damage to the nerve due to conditions like multiple sclerosis, it can be treated using medicines like Kaishor-Guggulu, Tapyadi-Loh, Ashwagandha and Yashtimadhuk.

Since such patients may not tolerate local applications of medicines, treatment options like medicated fomentation may not be feasible in this condition. However, in some refractory patients who do not respond satisfactorily to the above mentioned medicines, other treatment options may be tried. Blood-letting from areas near the location of the trigeminal nerve, using leeches is a viable treatment option and may give considerable relief from pain.

It is important to note that treatment has to be given long-term in order to get good results and prevent recurrence.