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shattering new headache in long term migrane sufferer

I'm a 47 year old male, long term migraine sufferer who has responded well to botox and midrin.  Three days ago I came down with a flu-like illness, but there were no respiratory symptoms at all.  Fever (102.5), 7/10 generalized dull headache, muscle and joint pain.  No rashes or obviously stiff neck.

On day three I now have horrible bursts of pain along the left side of my head, an a 110 degree arc from my temple to behind my ear.  The bursts last only a few seconds but they take the wind out of me. They feel like I'm being cracked on the head with a bottle and then they burn a bit. They're coming around every 15 to 30 seconds x several hours.   There is also some pain behind my eye.

I've had a much milder version of this on the crown of my head every year or two, but nothing to really seek help for.  But this is agonizing. I can see why trigeminal neuraglia is so disabling!

Could my viral syndrome be linked to this occipital-neuralgia like picture?  If this is really a form of true neuralgia, could gabapentin or tegretol help quickly or do they always take days to weeks?

Thank you,

F R

3 Responses
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Avatar universal
MEDICAL PROFESSIONAL
Hi,

How are you? Has the pain recurred?

Did the pain resolve spontaneously or did you take any medications?

Pain that is resolved or aggravated by position may have underlying mechanical causes example is impingement of the sciatic nerve (sciatica).

Let me answer some of your questions:

The trigeminal nerve innervates most of the areas of the face. By placing your middle three fingers and spreading it onto the three divisions of your face : the first division includes the eyes, 2nd the nose and 3rd the lips you have an idea on the area this large nerve innervates.Trigeminal neuralgia thus commonly affects these areas and without direct innervation to the neck.Sensation over the anterior neck is provided by the cutaneous nerves of the neck.

Carotidynia as the name suggests usually involves neck pain and jaw pain since it follows the path of the carotid arteries. This may be associated by a sensation of a lump in the throat when swallowing,throat redness or a palpable mass in the neck.However, these may be rarely seen.

Occipital neuralgia affects the occipital nerve that innervates the back of the head. This usually is associated with trauma unlike that of trigeminal neuralgia and carotidynia that may be associated with a previous infection usually of the repiratory tract. However, certain studies show that pain stimuli over the forehead ( innervated by trigeminal nerve) may actually be felt in the back of the head ( greater occipital nerve).Thus, pain over the greater occipital nerve dermatome may not readily rule out a trigeminal nerve disorder.

I hope this helps.
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Avatar universal
Thank you for your answer!  It is a few days later and the pain is completely resolved.  It actually got better once I laid down for hours in the only position that alleviated the pain--face down with my head completely turned to the left (the pain was right sided).  That made me wonder about a mechanical component.   Since it crossed well into the greater occipital dermatome, would Trigeminal Neuralgia still be considered?  could you still get carotidynia even withhout neck or lower facial pain?  

Any sites or articles you could refer me to?

Again thanks for taking time to answer my question.
Helpful - 0
Avatar universal
MEDICAL PROFESSIONAL
Hi,

Trigeminal neuralgia may be a likely cause for your condition.Another differential would be carotidynia which is sharp pain over temples and neck. Trigeminal neuralgia may be idiopathic ( most cause unknown) although infections were attributed to lead to the condition.

With a history of chronic migraine, these new onset headaches may still be migraine in a more severe presentation

For complete assessment a consult with a neurologist will help in excluding more serious underlying causes. This will also relieve you of unnecessary worries.

Gabapentin is initially given at low doses .The dose is gradually increased to a dose that relieves the symptoms but do not lead to side effect ( dizziness, fatigue). If the symptoms disappear for 4 weeks , the dose may be tapered gradually. Return of symptoms may warrant institution of the drug. Patients response to the drug varies.

I hope this helps.Good luck!
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