Diagnosis

The pain is not continuous, but comes on in paroxysms at irregular intervals. At first it may be slight, like the commencement of a common toothache, but it gradually increases in severity, until the patient may become almost wild with the pain. The pain is of a lancinating, tearing, beating or boring character, and follows the course of the nerve. After the pain has continued a certain length of time, it gradually subsides. The more severe the paroxysm, the shorter its duration. Where the pain commences at a point in the eyebrow directly over the middle of the eye, it generally extends to the eyebrow, forehead, eyelids, and frequently deep in the orbit of the eye. If it commences at a point about the middle of the cheek bone, it may extend over the cheek, lower eyelid, upper lip, and radiate to the teeth, palate, and tongue. Where the pain commences about the middle of the chin, it may extend to the lips, teeth, sides of the tongue, and the soft parts under the chin. Thus, whatever nerve is affected, the pain may be traced along its branches. There may also be a reflex action of the nerves of motion, producing an involuntary twitching of the muscles of the affected part.

The intervals between the paroxysms may be of hours, days, or even weeks' duration,. but the longer they continue the more frequent they become, until at length the nerves may become so sensitive that the paroxysm is excited by the slightest emotion, or by the least touch, or exposure to cold air.

Causes

It may be complicated with rheumatism, or be the result of cold, wounds, contusions, affections of the teeth and abdominal organs, suppressed chronic eruptions, carcinomatous, psoric, or syphilitic dyscrasia.

Treatment

Aconite. - In inflammatory or rheumatic prosopalgia, where there is considerable heat and swelling. The pain is throbbing, burning, shooting or stitching, worse at night, appearing in paroxysms and accompanied with great sensibility of the whole nervous system.

Belladonna

Paroxysm commencing with an itching in the affected part, and changing to a violent lancinating, aching, crampy or drawing pain in the check and nasal bones; the pain is on one side, and is frequently accompanied with an increased secretion of saliva or tears. Agravationg of pain from the slightest movement, noise, warmth of a bed, or a current of air. Twitching of the muscles of the face.

Dose

Two drops, or twelves globules, in a tumbler half full of water, a tablespoonful during the violence of the paroxysm every half hour or hour, gradually increasing the intervals as the pain abates.

Bryonia

Particularly in rheumatic persons, and where the pains are of a pressing, drawing, lacerating or piercing character; mitigated by moving the part affected: pains in the limbs, and sometimes chilliness followed by fever.

Dose

Two drops, or twelve globules, in a tumbler of water, a tablespoonful every hour or two hours.

Chamomilla

Great sensibility and extreme restlessness; swelling of the face; redness of one cheek and paleness of the other; drawing, tearing or pulsative pain, with sensation of torpor in the part affected.

Dose - Same as Bryonia.

China

Stitching, pressive, or beating pains, particularly in the cheek bones, aggravated by the slightest contact; sensation of torpor, and paralytic weakness in the parts affected.

Dose

Same as Bryonia.

Colocynth

Violent rending, or darting pains, principally on the left side of the face, and extending to the ears, temples, nose, and teeth, and all parts of the head, aggravated by the slightest touch.

Dose

One drop, or twelve globules, in a tumbler half full of water, a tablespoonful once in one or two hours.

Coffea

Insupportable pain, and great excitability of the nervous system.

Arsenicum

Violent burning, or tearing pain, worse at night, or during repose, and relieved by the application of external heat. Great prostration, and sometimes a sensation of coldness in the affected parts. Tendency to periodicity in the attacks.

Dose

A powder, or six globules, once in two or three hours.

Hepar-S

Pains in the bones of the face, aggravated by the slightest touch; aggravation in the evening.

Platina

Sensation of coldness, or torpor in the affected part, with severe spasmodic pain; or tensive pressure in the bones adjoining the ear, with a sensation of creeping or crawling; worse in the evening, or at rest.

Dose

A powder, or six globules, once in two or three hours.

Spigelia

Violent tearing or jerking pain, aggravated by the slightest touch, or by movement of the parts, or pains appearing to shoot from the centre of the brain to the sides of the head; pains of an aching, pressive character, sometimes with glossy swelling of the affected part

Dose

Same as Belladonna.

Rhus

Stinging, burning, or drawing pain, or pain as from subcutaneous ulceration; worse during repose and in the open air, and relieved by movement or warmth.

Dose

Same as Bryonia, with which it may sometimes be alternated.

Mercurius

In rheumatic persons, with aggravation of pain at night, and nightly perspiration; sensation of coldness in the parts affected, and great debility.

Dose

A powder, or three globules, once in two or three hours.

Nux-V

Especially in persons addicted to spirituous liquors, and those of a lively and choleric temperament, or those who lead a sedentary life. Drawing and jerking pain, aggravated in bed, in the cold air, and during meditation.

Dose

A powder, or three globules, once in three or four hours.

Pulsatilla

Lacerating or pulsative pain on one side, worse on lying down and during repose; relieved in the open air. Particularly useful in women and persons of a mild or timid character.

Dose

Same as Bryonia.

Sabina

Pains of a violent lacerating and throbbing character, occurring during menstruation.

Dose

One drop, in a tumbler of water, or three globules on the tongue. Give every hour or two hours.

Kalmia

This remedy has been given with marked success in the more violent forms of Prosopalgia, where the pains are of a violent lacerating or throbbing character.

Dose

Three drops, in six tablespoonfuls of water, a tablespoon-ful every hour.

Where the attacks are intermittent in their character, coming on at stated intervals, it may be necessary to give Quinine. From a half to one grain may be given during the interval between the attacks, once in four hours.

Where the pain is excessively violent, it may be advisable to bathe the parts with a mixture, composed of six drops of Aconite, to four tablespoonsful of water, Staphysagria may also be applied in the same manner. The external application may be warm or cold, accord-ing to the feelings of the patient.