Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Subject: Re: atypical facial pain
Forum: The Neurology and Neurosurgery Forum
Topic Area: Neurology
Posted by CCF Neurology MD - AY on September 30, 1998 at 15:29:21:
In Reply to: atypical facial pain posted by wendy on September 28, 1998 at 18:41:47:


my 11 year old daughter has suffered from atypical facial pain for the last 5 years. She had mastioditis and isolated sphenoid sinusitis, and still has severe pain on the laft side of her face, eye and head. She is currently on 900 mg of tegretol and 20mg of paxil/ day and has had relief of the symptoms. She had an infection last week and it flared the pain again. now the neurologist wants to increase the tegretol to 1000 mg/day. how long can a child remain on tegretol at these levels and are there any other alternatives? Is there any research as to what may cause a flare of the pain so we can help her to avoid those situations if possible? Thank You.

Thanks for your question. The symptoms described in your message are
suggestive of a trigeminal neuralgia, that is a localized pain the innervation
territory of the fifth cranial nerve, or trigeminal nerve. Trigeminal
neuralgia can often be associated with a Herpes Simplex viral infection
(which can be completely asymptomatic, except for the facial pain). Often,
even with the resolution of pain symptoms, viral particles will remain
in the trigeminal ganglion. An incidental external factor, such as other
viral infection or a bout of fever can trigger a reccurrence of the trigeminal
pain. Unfortunately, there are no clear preventive measures for such reccurrences.

The planned increase in Tegretol dosage is below levels where one would see
significant side effects. As you are probably aware, tegretol is very often
used in epilepsy, and assuming that your daughter is of normal stature and
weight, her dosage of tegretol is NOT unusually high. Another anti-epileptic
medication also used in neurogenic pain is Neurontin.

I hope this information is helpful. Best of luck.

This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.

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