THERAPEUTICS OF TIC DOULOUREUX By Walter J. king

Trigeminal neuralgia (TN), tic douloureux, prosopalgia, the Suicide Disease or Fothergill's disease is a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve. These episodes of stabbing pain may be paroxysmal and usually there is no pain between attacks. Most of the time this is unilateral disorder and most patients are above 50 years.

The following article was published in THE CRITIQUE, Vol. 5, 1898, on page 14-19.

THERAPEUTICS OF TIC DOULOUREUX

Compiled by Walter J. King, MD

Tic douloureux, or neuralgia of the facial nerve, is characterized

by intense, darting pains, indescribable or excruciating;
coming on in paroxysms of shorter or longer duration; usually
but one side affected.
Dry heat is often of great service; applied locally.
Attention to hygiene and the use of electricity are often
valuable aids in perfecting a cure. Fats should enter largely
into the diet.

ACONITE NAP.  Left side; face red and hot; violent stinging

 pains, with restlessness and anguish; from exposure to dry
west winds; worse at night; acute congestion and active inflammation.

ARGENT. NITR.  Sonet of head feel as if separating, or
the head feels as if it was enormously large; pains increase to
such a degree that the patient almost loses her senses; relieved
by binding the head up tightly; at height of paroxysm, unpleasant

sour taste in the mouth, and the attack ends in vomiting.

ARSENICUM ALB.  Burning as of red-hot needles; worse
about midnight, relieved by heat; face pale, shrunken and distorted;

 great restlessness; typical paroxysms of miasmatic or
purely nervous origin.

BARYTA CARB.  Left side; chronic or anaemic form; sensation

as if the skin were covered with cobweb.

BELLADONA. Right side; worse from light, noise, touch, or
the slightest motion of the eyelids or jaws, face flushed; pains
come and go suddenly; worse towards midnight.

BISMUTHUM.  Relieved by taking cold water in the mouth
and walking quickly about.

CACTUS GRAND.  Right side; tolerable only while lying still

in bed; caused by wine, strong light, music or missing dinner at
usual hour; returns daily at same hour.

CAPSICUM.  Patients of lax fibre; burning pungent pain,
worse from slightest draught of air, either warm or cold.

CAUSTICUM.  Right side; from malar bone to the mastoid
process; aggravated at night; better by rubbing with cold water;
chilliness.

CEDRON.  Chronic intermittent,  prosopalgia always coining
on at 7 or 8 p. m., lasting two to four hours; intense, burning
pain wandering from one place to another, although emanating
from a carious tooth; puffiness of the face.

CHAMOMILLA. Hot perspiration about the head; twitching
in eyelids, eyeballs, lips, and facial muscles; patient screams,
can't endure pain, is wild and unruly, tossing and rolling about.

CHELIDONIUM.  Neuralgic pains across eyes from left to
right, accompanied by most profuse lachrymation and dread of
light; right sided supraorbital and temporal neuralgia.

CHINA.  Violent, tearing, laming, burning, left side, every
morning; worse from draughts of air, slightest touch, lying down
and in the night; great weakness after the paroxysm.

CHININUM SULPH.  Recurring same hour every day; intervals

 free from pain; no complication with gastric or other derangements.

CIMICIFUGA.  Reflex from uterine or ovarian affection;
sensation of heat of vertex, or as if the top of the head would fly
off; pain goes off at night and reappears the next day; frequent
flushes of heat, want to be in the open air.

CINA.  Pain as if both malar bones were pressed together
with pincers; worse from external pressure.

COFFEA.  Excited nervous erethism; headache, as if the
brain were torn or would be dashed to pieces, coming on during
walking in the open air; worse from heat; clavus.

COLOHICUM.  Remarkable tolerance of pain; general semiparalytic

 condition; left sided; tearing and tensive pains in
facial muscles, moving from one location to another; drawing in
bones of face and nose, with sensation as if they were being
rent asunder.

COLOCYNTHIS.  Tensive tearing with heat and swelling; left
side; caused and aggravated by chagrin or indignation; worse

from touch or motion; better in perfect rest, and from external
application of warmth.

CONIUM MAC.  Right side; bluish swollen cheek, with sore-
ness as from excoriation; worse from cold and from eating and
drinking.

FEERUM MET.  During the paroxysms the face gets fiery
red; during intervals the face looks earthy and pale; cannot keep
the head quiet; after overheating and cold washing.

GELSEMIUM.  Acute, sudden, darting and shooting pains,
with contractions and twitchings of the muscles supplied by
the affected nerves; muscles sore; inability to raise affected
eyelid.

HEPAR SULPH. Chronic cases; pains in malar bones, extending

to temple, ear and upper lip; worse in the fresh air,
better from wrapping up the face; at the same time coryza,
hoarseness, much sweating, and rheumatic pains elsewhere;
especially after the abuse of mercury or metallic preparations.

IGNATIA.  Supraorbital; convulsive twitching of facial muscles;

 pain felt only when touching the part; clavus hystericus;
forcing and pressing out pain.

IRIS VERS.  Pain in head, temples and eyes, attended with
most distressing vomiting of sweetish mucus, and if attended
by much straining with a trace of bile; relieved by vomiting.

KALI BI.  Pain in left upper maxillary, shooting towards
the ear; supra-orbital with gastric disorder; face pale; cold
sweat on face and body; weariness after the pain.

KALI CARB. Stinging in cheeks, with tearing stitches into
forehead, eyes and temples.

KALMIA. Bight half of the face; rending, agonizing or
stupefying neuralgia of superior maxillary branch and of teeth,
not from caries but after exposure to cold; worse from worry,
mental exertion or heat; better from cold.

LACHESIS. Left sided orbital neuralgia; lachrymation, rising
of heat in face before, and weak, nauseous feeling in abdomen
after attack. Delirium appears as soon as the eyes are closed.

MAGNESIA PHOS. Darting, tpasmodic pains; relief from
pressure and warmth; patient languid, tired, and exhausted.

MERC. COR. Tearing pains, worse at night in bed; ptyalism;

 constant inclination to perspire, especially of affected part,

but perspiration does not relieve the pain; recent cases from
cold and chill; from syphilis.

MEZEREUM. Left side ciliary neuralgia with lightning-
like pains extending to neck; from carious tooth (Kreosote,
Staphisagria); numbness in the region of the pain; constant
chilliness, but pain worse from heat; pains come on with great
suddenness; or come on daily, increasing from 9 a. m. to 12 m.
and then decreasing until 4 p. m.

NATR. MUR.  Pain in malar bones, worse from chewing;
periodically, especially after checked ague; great thirst.

Nux VOMICA.  Patient is morose, irritable, belches a great
deal, and is constipated; worse from coffee, liquor and quinine;
face numb, with flow of clear water from eye and nostril of
affected side.

PHOSPHORUS. Neuralgia following nervous strain from
great mental exertion or excitement, with tinuitus aurium and
vertigo; worse from every movement of the muscles of the face;
from taking cold over the washtub.

PLUMB MET.  Burning, neuralgic pains, relieved by diversion

 of the mind by some new topic, or by any excitement or
change of position.

PLANTAGO MA JOR.  Left side; shooting, tearing pains extending

 from jaw into ear.

PLATINA. Right sided; painful feeling of numbness in
malar bone, mastoid and chin, as if parts were between screws;
with anxiety, weeping, and palpitations; profuse lachrymation
and swelling of face; worse on rest and at night; wants to rub
the part.

PULSATILLA.  Jerking, tearing pain, worse in the evening
and in a warm room, or when chewing, talking, or from hot or
cold things in the mouth; tearful disposition; excited nervous
erethism.

RHODODENDRON. Violent, tearing, jerking faceache; worse
from changes in weather or from wind; better from warmth and
while eating; neuralgia of dental nerves; great weakness after
he pain.

RHUS TOX.  After getting wet; feeling as though the teeth
were too long, with drawing, burning, tearing pains necessitating
moving around; great restlessness; relieved somewhat by the
external application of cold.

ROBINIA.  Left side; sensation of disarticulation and fracture

of jaw bone; whole features of patient changed by the
neuralgia.

SANGUINARIA. Must kneel down and hold head tightly to
the floor; lassitude; torpor; spongy bleeding gums; shooting,
burning pains.

SEPIA. Intermittent faceache, with congestion of eyes and
head; shuddering; pain not felt during violent exercise, as walking

in the open air; relieved by warmth; nausea and vomiting;
jerking like electric shocks, upwards; neuralgia during pregnancy

 or the menopause.

SPIGELIA. Sticking, darting pains affecting the right
temple, orbit and eyeballs always attended by feeling of anxiety
at heart, and great restlessness and intolerance of pain; parts
become swollen and very sore; flow of water from eyes and nose;
worse in damp weather from touch or motion; periodical from
morning until sunset, worse at noon.

STANNUM. Gradually increasing and then gradually de-
creasing; feels as if she would faint; prosopalgia after ague, sup-
pressed by quinine.

STAPHISAGRIA.  Pressing and beating pain extending from
the decayed tooth to the eye; worse from slight pressure or from
contact of a metallic substance, better from heavy pressure;
spasmodic weeping; cold hands and cold sweat on face.

STRAMONIUM.  Pain in cheek near left ear, as if sawing the
bone; twitching of the muscles of face; spasms of the chest
hindering breathing; frowning; prosopalgia nervosa; pains maddening;

delirious talk, with open eyes; grinding of teeth.

SULPHUR.  Psoric tendency; chronic cases, where other
remedies fail.

TARANTULA.  Pain in angle of inferior maxilla, so severe as
to think he is going crazy; dizziness; vanishing of sight and
lugging in ears.

THUJA. After suppressed gonorrhoea, or eczema of ear;
sensation as though a nail were being driven into the vertex or
frontal eminences; intense stabbing pain drives almost to distraction;

must lie down; pain changes from left to right; better
at night; painful spots burn like fire and are sensitive to the sun

VALERIANA. Hysterical neuralgia; pains appear suddenly

and in jerks; fierce pains through left side of face, darting into
teeth and ear.

VERATRUM ALB. Icy coldness of part; copious cold perspiration;

 great exhaustion; nausea and vomiting; drawing,
tearing pains, with bluish pale face and sunken eyes; pains
worse in damp weather; right side or left to right; tearing in
cheeks, temples and eyes, with intense heat and redness, driving
to madness.

VERBASCUM. Violent pain, jerking like lightning, or crushing

 as with tongs; especially right zygoma; brought on by pressure,

 sneezing, talking, chewing, change of temperature, or
exposure to cold air; daily from 9 a. m. to 4 p. m.; attended with
feeling of fullness in the head, vertigo, belching, discharge of
tough saliva, together with great coldness of the rest of the
body.

ZINCUM. Burning, quick stitches, and jerking along the
course of right infraorbital nerve, attended with bluish eyelids;
cold sweat on forehead; numbness of tongue; sensation of constriction

 in throat; worse from the slightest touch, and in the
evening.