I suffer severely from trigeminal neuralgia, which is not relieved by painkillers. What causes this dreadful pain?
The trigeminal nerve leaves the brain and passes through a hole in the skull just beside the ear. From there it fans out across the face to receive sensations from the skin of the face and to give instructions to the muscles in the face.
Neuralgia is nerve pain, and patients with trigeminal neuralgia (also known as ‘tic douloureux’) experience sudden, severe pain in the trigeminal nerve. The pain often arises beside the mouth, and spreads almost instantly up to the eye, down to the jaw, and across to the ear. The pain may last a few seconds or several minutes. Only one side of the face is affected.
Attacks of pain may be started by cold winds, eating, yawning or touching the face. The pains tend to come in episodes, with attacks coming every few minutes for a few days or weeks, and then disappearing for a time. Unfortunately, each successive attack tends to last longer than the preceding one, and the pain-free periods become shorter.
Occasionally, trigeminal neuralgia may be caused by a brain or nerve disease
such as multiple sclerosis, but usually there is no specific cause, and there are no tests available to prove the diagnosis.
A number of drugs can be used to control the condition. Pain-killers are not particularly effective, but antiepileptic drugs are quite successful.
If these medications prove unsuccessful, surgical exploration of the nerve may find an area of compression or abnormality as a cause of the pain. Very rarely, as a last resort, the nerve may be destroyed to give relief from intractable pain, but this leaves the face numb and paralysed.

I awoke last week with half my face paralysed. I am very scared, but my doctor says it will get better in a few weeks and she won’t give me any treatment. She says it is a Bell paralysis. What should I do?
You should not worry. Your GP is doing just the right thing—nothing!
The muscles of the face are controlled by the facial nerve, which comes out of a hole in the skull just below and in front of the ear. From there it spreads like a fan across the face, with branches going to each of the many tiny muscles that control our facial expressions. Damage to this nerve causes all these facial muscles to stop working, because the nerve tells the muscles when to contract and when to relax. The patient can no longer smile or close the eye properly.
By far the most common cause of this type of paralysis is Bell’s palsy. Bell’s palsy is caused by an inflammation of the facial nerve as it leaves the skull. The exact reason for this inflammation, and subsequent paralysis, is unknown. When the condition starts, the patient develops a sudden paralysis of the face muscles on one side only. There may be some mild to moderate pain at the point where the nerve leaves the skull beside the ear, but this settles after a few days. There may also be a disturbance to taste sensation.
Two-thirds of patients recover completely within a few weeks with no treatment. Most of the others obtain partial recovery, but 10% are significantly affected long term by facial paralysis. No treatment is necessary for most patients, but if the victim is elderly, the paralysis is total, or if there is severe pain, treatment may be tried. High doses of prednisone, a steroid, to reduce the inflammation in the facial nerve, is the usual medication. It is important that the treatment start within five days of the onset of the condition. Unfortunately, there is varying evidence about the value of any treatment, but at least it rarely causes any harm.

I have been suffering from migraine headaches periodically, for several years and am on medication for the same. Of late I’ve kind of gotten tired of taking these drugs. There’s no permanent cure for migraines. I would like to try something different.
1. Can acupuncture relieve migraine headaches?
2. If yes, when should I seek out an acupuncturist — before a migraine develops or after?
3. What will the treatment involve and how long will it take for pain relief to set in? Will it take longer than drugs?
4. How much will it cost, and how many sessions will it take? What are the risks involved?
5. Most importantly, how do I know whether an acupuncturist is qualified to treat? Is there a certificate or degree that I should look out for?
1. Yes, acupuncture can relieve migraine headaches and can often lead to a cure.
2. Before is better but acupuncture can help even during an attack.
3. The treatment involves insertion of needles into acupuncture points on the head, arms and legs. Pain relief is usually in the first 5-6 sessions. In acute attacks pain relief can occur within 5-7 minutes which is faster than any drug.
4. Cost varies according to the location of the practitioner, his experience, type of needles and equipment used. The treatment usually takes 8-20 sessions.
5. Ask around among your friends and acquaintances if they have been treated by a good acupuncturist. If the treatment has worked on them it is likely to work on you. A diploma in acupuncture is about the minimum qualification. Certification in India is not a reliable guide to the competence or knowledge of the acupuncturist. Speaking to patients of the acupuncturist will be a more accurate indicator of competence.