Clinical Cases

Two Cases of Trigeminal Neuralgia

Kathrine Dehn
Written by Kathrine Dehn

Homeopath Kathrine Dehn presents two cases of tirgeminal Neuralgia in women of 89 and 80.

CASE 1

Woman 89 years old.  First seen 19.8.2016.   Presenting symptom: Trigeminal neuralgia, which started 2009 and has been there every year since then. Always right side. This year it occurred in the supermarket on 24.4 “as if somebody cut into me.” It began in July.

“The pains are like a sparkler. Not hot, but stitching and prickling. Now it is like a throbbing toothache. I scream when I chew food. I cannot eat. There’s pain when I talk. The attacks can last minutes or hours. Before there was no pain at night, so I could sleep, but now I cannot lie down. I have been prescribed three different kinds of medicine that do not agree with me: Lyrica, Tegretol and now I take Tradolan. I took a course of 56 Lyrica tablets but that did not work. I have paroxysms every 30 minutes. Worse movement. I cannot swallow my saliva. I cannot feel my throat. Can only eat yoghurt and banana. I have lost 6 pounds. I cannot touch my skin on the face. It will set it off. I drink tea in the morning, but as soon as the cup touches my mouth it starts. It is not the heat of the tea, but the touch of the skin. I cannot brush my teeth. When I took the Lyrica tablets I had hallucinations. Saw a white ghost waving its hands. Saw 3 ks in one word. I was very constipated. The Tradolan gives me vertigo and constipation. I am very constipated.”

“No problems with my teeth. Had cystitis 5 years ago. Had herpes zoster on my chest back in the 80’s after a car accident. In the 70’s I had zone therapy for sinusitis. That was actually the right side too, and the pains were similar to the neuralgia. Lump in my right breast in 76 – benign.”

Desires beer. Very unusual.

Desires liquorice.

“I have suddenly got a red rash all the way up the right leg. It itches.”

Daughter had breast cancer (right)

Objectively:

The woman is physically fit for her age and well dressed. She is very astute and well spoken. It was obvious, however, that she was very unwell, and just wanted the interview over and done with, so she could go home. She concentrated on the problem in hand and did not divert to anything else or divulge emotional or mental symptoms apart from the hallucinations that appeared on the drugs. She had no idea why the symptoms had started originally, or what could have triggered them.

Repertorisation:

FACE – PAIN – Nerves – Trigeminal neuralgia

FACE – PAIN – neuralgic

FACE – PAIN – opening the mouth agg.

FACE – PAIN – motion – agg.

FACE – PAIN – talking – agg.

MIND – SHRIEKING – pain, with the

GENERALS – SIDE – right

GENERALS – PAIN – morning

GENERALS – EVENING

FACE – PAIN – chewing – agg.

GENERALS – FOOD and DRINKS – beer – desire

GENERALS – FOOD and DRINKS – sweets – desire

SKIN – ERUPTIONS – herpes zoster

CHEST – TUMORS – Mammae

I differentiated between Bryonia, Belladonna and Chamomilla. Although I thought about Chamomilla as it has a tendency to neuralgia and shrieking with the pain, I decided against it as the modalities did not fit as well as Bryonia and it is predominantly a left sided remedy according to Hering. Chamomilla is generally affected by the temperature of the food which this woman is not. It is interesting to note that Bryonia also has shrieking with the pain. The woman kept saying that it was more to do with the motion than anything else. Even though Belladonna has the modality “motion aggravates” it does not have an aggravation from opening the mouth and from talking, and those modalities seemed very important in the context of the case because of the motion. So despite the fact that the pains appear suddenly as in Belladonna, the pains in Bryonia tend to appear gradually I opted for the Bryonia as the overall picture seemed to fit better. Bryonia has a delusion of ghosts as well.

She was given Bryonia 30c to take immediately and one to take if she had an attack.

Follow up 8.9.2016

“First a relief. Decided to stop the tradolan, now I use homeopathy. The day after I took the tablet I got attacks at 11 pm a bad one at 3pm and at 6pm. I stood them out, but at 2 am Saturday night it was so terrible I sat and shrieked so I repeated the Bryonia 30c. I had not slept, but after the tablet I collapsed and fell asleep. Sunday morning awoke with no pain. First I tried to eat my yoghurt very carefully, but there was no pain. During Sunday my urine turned red like it was during my cystitis 5 years ago.  And suddenly Sunday afternoon I just wept and wept. Very unusual.  My constipation was better immediately. I had not had any motions for 6 days, but after the first tablet I had to go to the toilet nearly straight away. I have had a few minor attacks, but they did not last long now and I can eat what I feel like. No problems swallowing. I have put a bit of weight back on.

My mood is much better. I can now mow my lawn again and attend to the house. I must say I am getting a bit lazy though. My urine is back to normal. The rash on my right leg disappeared gradually within the first fortnight. I sleep better. No vertigo

Objective

The remedy is working according to Hering’s law of cure. The recent symptoms are disappearing (the rash and the neuralgia and the constipation) and old ones returning (the red urine). The strong weeping could both be a reaction to the remedy, but also a reaction to the withdrawal of the Tradolan. I have experienced Bryonia to be a very effective remedy to aid people with strong pains when coming off allopathic drugs, including opioids – obviously if the remedy is indicated.

No Rx but given Bryonia 30c and 6x to take in case the neuralgia returns.

Follow up 31.10.2016

I had a real big relapse on 20.10.17 I shrieked with the pain. Woke up in a lot of pain 2am. Had to take a Bryonia 6x. It helped straight away. It coincided with me having to deal with my financial situation the next day. I used to work for a bank, and I had some special arrangements with them due to my prior employment. Suddenly they had informed me that they did not want arrangements with old age pensioners. So I had to reconsider my whole financial situation. I have dealt with it. Been to the bank, changed banks, and I am better now.

Objective

This was a very interesting piece of information as it is fully in line with the Bryonia make up to worry about financial matters.

No Rx – We have agreed that she contacts me if necessary, and that she can take  Bryonia if necessary.

Telephone call in August 2017.  She has been very well since last year and symptoms have not reappeared for the first time since 2009.

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CASE  2

Woman 80 years old – First appointment 4.9.2004

Presenting symptom:  Trigeminal neuralgia.  Left side. It has always been on the left side. First attack was in 1989 and it just came out of the blue. It always starts on the dot in the evening 8.30 pm. I was prescribed Tegretol. After 3 tablets I could not think clearly. I could not work out what to say.

From 1990 –19 94 I had acupuncture. That helped. Always starts on 1.4. After 1994 the acupuncture had no effect and I was again given Tegretol. Then I fainted. So I stopped the tablets and had laser treatment at the dentist. That worked for a few years. Then I saw an anthroposophic doctor. He gave me: Apis, Arnica, Rhus-Tox And Aconite. It worked somehow, but then stopped working.

I have sciatica in my left leg. Always worked on a stone floor. That has been hard for my legs. The sciatica is better for sitting still. But if I sit down for 3 days then it is worse.

I have had a recurrence of sinusitis in my left side. When I was 50 I was in hospital because of a huge swelling on the left side of my face due to sinusitis. It was like an egg.

I had an ulcer on my uterus at some point.

When younger I suffered from tonsillitis and had my tonsils removed when 18 years old.

I wake a lot in the night and have to urinate 3-4 times a night.

Other than that I am well. Quite balanced mentally and emotionally. I am quite warm usually. Get heated quickly, but I have cold legs. Heavy legs.  Had it for years.

I am not a weak person. I work with people in self-help groups now and I visit the elderly on a voluntary basis. I fear the attacks of the neuralgia, and when I do have them I want to jump out of the window. They come on suddenly, but disappear gradually. Now I have the attacks about twice a day and once a night. They can appear at different times, and one attack lasts about 20 minutes. The pain starts at the nose extends across the upper jaw and to the eye and forehead. It may start spontaneously if I touch it. Eating makes it worse. I do not have to touch or chew as long as the spoon comes near the face it starts. Worse brushing my teeth. The pains are like very powerful shocks or blows.

I have a sweet tooth. I love cream cakes and sweets. Love all kinds of fruit.

I suffer from high blood pressure.

Repertorisation:

FACE – PAIN – Nerves – Trigeminal neuralgia

FACE – PAIN – Nerves – Trigeminal neuralgia – left

FACE – PAIN – left – neuralgic

FACE – PAIN – electric shock; as if

FACE – PAIN – inflammatory

FACE – PAIN – touch – agg.

GENERALS – PAIN – appear suddenly – disappear; and – gradually

GENERALS – SEASONS – spring, in – agg.

GENERALS – PERIODICITY – year – every

EXTREMITIES – PAIN – Lower limbs – sciatica – left

EXTREMITIES – PAIN – Lower limbs – sciatica – motion – agg.

MIND – SUICIDAL disposition – throwing – windows, from

In this case Belladonna came up along with Lachesis. Belladonna has the neuralgic symptoms, but is predominantly a right sided remedy. Looking at the woman’s past history of especially recurrent tonsillitis and sinusitis with symptoms similar to the neuralgia, but also the present hypertension combined with Lachesis’ tendency to periodicity once a year and in the spring, the totality of symptoms justified the choice of Lachesis.

On perusing the Guiding Symptoms Of Our Materia Medica by Hering, the trigeminal symptoms described matched pretty well those of the patient. The only thing that did not quite match the symptom picture was the character of the pain; the sensation of a shock or a blow, but I did not find that that was enough to decide on a different prescription.  At the time the patient was 80 and her pains were so severe I did not want the remedy to cause an aggravation (which in my experience Lachesis may do in a 30c) so I decided to start low.

Prescription: Lach 12 c

Follow up 5.10. 2004

My face is fine. I hardly feel anything in my face. I have had no attacks since the  Lach 12c. I can even apply lotion on my face now. But after the remedy I got a lot of pain in my legs and feet. That has come on the last few days. I used to suffer from headaches. That has returned a bit. My stomach works better. Natural stool several times every day. I used to eat a natural medicine to keep the stomach in order, but I do not need to now. I have been able to clean my house. I could not do that.

Objective

The remedy is working according to Hering’s law of cure. Return of old symptoms while the most recent symptoms have gone.

No Rx but Lach 12c to take if there’s a relapse.

Follow up 13.12.04

I had to take a Lach 12c on 22.10. as my legs became very painful. Much better the next day. On 6.11 my throat felt like it did when I had my tonsils out at 18. I feel much more relaxed when my legs are okay. I used to take pain killers for my legs. I do not need to take anything now. My sciatica is not bothering me so much. And my legs are not so cold. My eyes used to burn and itch, but that has stopped. I have had a return of some inner restlessness I used to feel when I was about 40. It is better now, but still there a bit.

My blood pressure is 185/80

I feel better. Grateful for each day now that I am 80.

No pain in my face.

No Rx- Lach 13c to take if necessary

Follow up 24.5.2005

No return of pain in face. Spent the winter in Portugal. I usually do that. Repeated the Lach 13c after a bout of flu in March. My legs had started to ache again. Legs are generally better. No pains in eyes. My stomach functions well.

No Rx, but Lach 13 to take when necessary.

Objective

For years I did not see the old lady, but she contacted me again 9.6.16 as she had high blood pressure again and cataract of her right eye. She could hardly see. She had a repeat of Lach 12c and Sepia 9x. After that her blood pressure went down to 140/70 and her vision became much better. She has had no return of the neuralgia since 2004.

About the author

Kathrine Dehn

Kathrine Dehn

Kathrine Dehn has worked as a homoeopath since 1992 when she qualified from The British School of Homeopathy. Part of her practice has been from her home, in Denmark. She has also been given the opportunity to practise at a school in Copenhagen for several years due to collaboration with the Principal. From 1993-1998 she studied medicine at the University of Copenhagen and in 2010 completed an MSc in Homeopathy from UCLAN in the UK.

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