Facial pain

I am a 51 year old female with chronic facial pain.  The areas of pain are related to the location of my sinuses. It is a throbbing pain and I have had it for several years. I have seen a ENT, an allergist and now am being treated by my MD for migraines. I am not having any success with the migraine meds.
I have had a sinus CT that only showed a deviated septum but the ENT was not concerned about it. I have tried sinus medications and nasal sprays but they do not stop the pain.
What area of specialization can help me put a name to my symptoms?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

I would suggest you see a neurologist who specializes in headache.

I will provide you basic information that may be useful on headaches and chronic headaches below:

Primary headache disorders are much more common than secondary ones. There are several primary headache disorders, over 50 different types.  For example  migraines, which usually a pulsating throbbing one-sided pain with nausea and discomfort in bright lights that lasts several hours. Another type is cluster headaches, which are sharp pains that occur around and behind the eye often at night and are associated with tearing of the eye and running of the nose. In primary stabbing headache, sharp or jabbing pain in the head occur, either as a single stab or a series of brief repeated volleys of pain. Primary stabbing headache often occurs in people with migraine. The pain itself generally lasts a fraction of a second but can last for up to one minute in some people. Another type of stabbing headache is called paroxysmal hemicrania. This is marked by episodes of stabbing or sharp pains that occur on one side of the head and may be associated with eye tearing or runny nose. Episodes may occur several times and last 30 seconds to a minute. Yet another type of stabbing headache is abbreviated SUNCT; 100s of stabbing pains lasting seconds occur and are associated with red eye and tearing.

In treating chronic headaches such as in yourself, the treatment may (based on your evaluation by a neurologist) include two types of medications: preventative therapy and abortive therapy. Preventative therapy is a medication that would be taken every day regardless of whether or not a headache is prevent. This type of medication is used to prevent headaches from occurring, and there are several types including but not limited to beta blockers such as propranolol, calcium channel blockers such as verapamil, and others including topamax, depakote, elavil, etc. A lot of these medications were invented for other uses and are used not only for headache but also epilepsy and depression. They have proven very effective in preventing headaches. The second medication is abortive, meaning it is used when a headache is coming on. The medication used depends on the nature of a headache. If it is a migraine type headache, a group of medications called triptans can be used. And so on. However, with frequent use of abortive medications including triptans, tylenol, advil, and others, medication overuse headache occurs. This requires a specific treatment in which the over-used medications are slowly stopped and replaced with more long-acting medications. Tylenol with caffiene, and similar medications, can cause medication overuse headache if used too frequently. Lyrica, which is used for fibromyalgia, can be used for chronic headaches too.

One of the most common causes of headaches in people with chronic headaches is called medication rebound or medication overuse headache: medications as simple as tylenol or advil if used too much can cause rebound headaches that are even worse then the headaches for which the medications were started for. This is very common and is most likely to occur with use of any medication for your headache more than a few times a week. It can occur with all the commonly used headache medications such as ibuprofen, triptans (such as imitrex), fioricet, and commonly with any type of narcotic such as tylenol #3, dilaudid, percocet, etc. The treatment is difficult, but basically involves weaning off the offending agent and replacing it with another that is later weaned off, combined with a more long-term solution. This should be done under strict guidance by a specialist, preferably a headache specialist, or else the headache will not improve and withdrawal side effects can occur.

Again, I would recommend seeing a headache neurologist.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[vbc2000]

Hi There,
I'm not a doctor, nor do I play one on TV, lol, but I had something similar in my 20's and would just like to mention it.

I swore to God I had a brain tumor the pain was so bad and so constant and I had facial pain as well.  Didn't have allergies at that time and was very disturbed by it all.  Went for a head CT scan that wasn't totally covered and nothing showed up...thankfully.  I was at my wits end but was at my dentist one day and was telling him about it and he suggested it might be TMJ.  He didn't see any teeth erosion meaning I wasn't grinding in my sleep, but it turns out I was clenching my jaw all day and not realizing it.  It was a really stressful time in my life and I was doing it from stress.  Got a book on TMJ, learned how to conciously relax my facial muscles and become aware of when I did it, and viola!  It was the answer.  I still do it to this day from stress, but the way I learned how to recognize I was doing it, and how to counter it has become second nature.  

This of course might not be your problem, but just wanted to throw it out there.  Good luck...I know how awful it is to suffer like that.  And by all means, see a Neurologist like the good Dr. suggested.
Stephanie