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Hormone-related facial neuralgia?
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Hormone-related facial neuralgia?

For the past 5 years, I've experienced intermittent facial neuralgia that seems to occur  around the time of ovulation. For the first few years, the incidents were wide-spaced, but since becoming pregnant with my second child over a year ago, they've become monthly. It's always the left side of my face and seems to originate at the top of my cheekbone. My cheek, scalp, ear, gums, and throat are usually affected; sometime my neck hurts too. It's painful to touch, and I generally feel flu-like -- achy, tired. I have ear aches and sometimes headaches. The attacks (?) last around 3 days. About 3 years ago I visited my MD about this; she sent me to an immunologist, because my glands also became swollen during the episodes. Because the attacks were sporadic, I didn't worry too much. Now that they're more regular, I'm a little worried and will call her soon to set up an appointment. I've read about TN but my pain isn't sharp or shooting -- just unpleasant and annoying.

Should I be worried? Can this just be a hormonal thing?
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Avatar_n_tn
Hi,

It looks like Trigeminal Neuralgia (TN) to me. Some patients show a correlation of attack frequency or severity with menstrual cycle.

You should not worry, as it usually respond to the medical treatment. I will suggest that you consult a neurologist.
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Avatar_n_tn
Really? Even though the pain isn't shock-like? It's more of a dull ache than anything else, though I do get the occasional stabbing pain in my ear. Yesterday the ache traveled down my shoulder and arm into my wrist, and my hand was extremely sore and weak.
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Avatar_m_tn
I would like to talk with you about your experience and what help treatment you found to be successful if anything. I am experiencing almost the exact symptoms, also after the birth of my second child. Mostly, mine is on the Right Side, but when I looked at my year-old charts it has been on the Left in the past. Like you, it is not "painful" like trigeminal neuralgia generally is, but it is more of a tingly numbness that then becomes a dull bothersome pain. It really does seem like a compressed nerve pain, that then after ovulation resolves. I use natural family planning, so I know that it is occuring on the day that I am about to ovulate. I thought at first it might be hormones out-of-balance because I was breastfeeding and cycling, but I haven't been BF for about 6 months now.

My OBGYN thinks that it might be "menstrual migraine" so we are doing a trial of imitrex-NSAID but I am more convinced that it might be a nerve-related condition, somehow related with immunology/estrogen? I am going to try the med next month when the symptoms start, but I am not hopeful.

I am not sure how to give you my contact information? I would really like to communicate by phone or email since I have never found someone with this same set of weird symptoms before.
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Avatar_n_tn
Hi,

I forgot I had even written this! I went to a neurologist who confirmed it is indeed a "facial" migraine -- apparently quite rare (she had to pull out her big neurology textbook) and subject to hormones. I do have a history of regular migraine, mostly when I was on the Pill. Now I only rarely get a regular migraine with aura and instead get the strange facial migraine that makes everything painful and sensitive, from the top of my scalp on one side, the cheek, the gums, and down my neck. I take NSAIDs when required. Hope this helps.
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Avatar_m_tn
Thank you for writing back! This helps immensely. Calms my nerves, ha ha. It's good to hear that you essentially got the same diagnosis, though I'm still not sure that this clarifies why it's happening. I realize it's probably the drop in estrogen, but I don't really understand why that upsets the facial nerve.

It's interesting to hear how you describe the location, for me it is the same. I can almost draw a line with a pen where the numbness/ tingling starts, then in progresses. It always starts along the cheek bone, then spreads to the forehead and cheek/jawline, sometimes the top lip if I remember correctly. For me it's always just one side of the face, not both together ... sometimes an annoying pain sets in, or my eye starts to be a bit "achy" but definitely not TN like pain.

As an aside/add on - After baby #2 was born (before these "migraines") I used to get this sorta tingly/creepy crawly feeling in my scalp. Like electrical bugs/static. It was the oddest thing. It would wake me in the night and drive me up the walls - nothing would make it stop. It was also hormone related, I charted it as well. Interestingly, usually it hit right before my period. It would happen and I'd think to myself, ok I'm getting my period when I wake up tomorrow, but sometimes it would also happen at ovulation. Estrogen drops at both of those points, so the theory holds true. That scalp business has stopped and I haven't had it for quite some time now - but it never concerned as much as the face thing did. My hormones were out of balance post-partum, loosing hair, baby blues, and the like, so I kinda just chalked it up to all that. I'd have to look back to see when the last time I had that was, but it seems like it was a long time ago (my "baby" is almost 2.5 now).

I wonder what it is about that second child that made our hormones go nuts - or is it the added stress, increased consumption of coffee that is pushing us over the edge? I also wonder if it will calm down as life mellows out and our bodies normalize, and also if it will come back with menopause flares?

In any case, I'm glad to hear what's working for you, if something changes for me I'll be sure to come back and share with you. I haven't filled the prescription yet, thought I would give the plain NSAIDs a trial first. I also started on the ever-popular b-vitamins just a couple times a week. We'll see - stay in touch if anything changes for you, it's nice to know there's someone else out there dealing with the same issue. Again, thanks.
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