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Headache. 2019 Mar;59(3):418-429. doi: 10.1111/head.13475. Epub 2019 Jan 17.

Topical Ambroxol 20% for the Treatment of Classical Trigeminal Neuralgia - A New Option? Initial Clinical Case Observations.

Author information

1
Institute for Pain Medicine/Pain Practice Wiesbaden, Wiesbaden, Germany.
2
Department of Neurology, General Hospital Fürth, Fürth, Germany.
3
Migraine and Headache Clinic, Königstein, Germany.

Abstract

BACKGROUND:

Trigeminal neuralgia is difficult to treat and shows upregulation of sodium channels. The expectorant ambroxol acts as a strong local anesthetic, about 40 times stronger than lidocaine. It preferentially inhibits the channel subtype Nav 1.8, expressed especially in nociceptive C-fibers. It seemed reasonable to try ambroxol for the treatment with neuropathic facial pain unresponsive to other standard options.

MATERIAL AND METHODS:

Medical records of patients suffering from classical trigeminal neuralgia (n = 5) and successful pain reduction following topical ambroxol 20% cream in addition to standard treatment are reported.

RESULTS:

All patients reported pain attacks with pain intensity between 4 and 10 NRS (numeric pain scale). In all cases they could be triggered, 3 patients reported additional spontaneous pain. Attacks were reduced in all 5 patients. Pain reduction achieved following ambroxol 20% cream was 2-8 points (NRS) earliest within 15-30 minutes and lasted for 4-6 hours mostly. This was reproducible in all cases; in one case pain was eliminated after 1 week. No patient reported side effects or skin changes; oral medication was reduced in 2 patients.

CONCLUSION:

For the first time, a clinically significant pain relief following topical ambroxol 20% cream in patients with trigeminal neuralgia is reported. In view of the positive side effect profile, topical ambroxol for patients with such a highly impaired quality of life should be investigated further as a matter of urgency.

KEYWORDS:

allodynia; ambroxol; facial pain; hyperalgesia; topical therapy; trigeminal neuralgia

PMID:
30653673
DOI:
10.1111/head.13475

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