Re: Change in Headaches - Neuralgia?

[anonymous-user__0]

Subject: Re: Change in Headaches - Neuralgia?

Forum: The Neurology and Neurosurgery Forum


Dear Doctor,
I am a 28 year old female with a sudden change in headache type.  I have had migraine headaches on the left side of my head since I was 14 years old.  Generally, they were infrequent and manageable with Midrin (first) and later, Esgic Plus (used sparingly, since one prescription lasted 6 months+).
About 3 1/2 years ago, I began to feel a continuos twitching in my left eye, which seemed to disappear after two weeks.  After which, I noticed ptosis of the left eyelid.  Also, while a headache was occurring, I had constriction of the left pupil.
Shortly after this, I became pregnant and had virtually no headaches during this pregnancy, or while nursing.  In December '98, just more than a year after my baby was born, my headaches seemed to become more frequent, but still manageable.
In Jan. '99, I awoke with a different type of headache, which has never gone away!  I experience a daily pain, which centers around my left eye, but is a burning sensation (unlike my migrain pain).  Sometimes there is a sharp/stabbing pain in the upper corner of my left eye that accompanies the burning feeling.  The burning sensation seems to vary in severity and location (eye, cheek and back of head) from day to day.  I feel the burning from the moment I open my eyes in the AM.
I have seen 2 Neurologists.  The first insisted that this was still migraine pain, which had changed form.  She gave me Amerge and Inderal, both of which had no affect.  All tests(MRI, EEG, X-ray and Blood) were normal.  The second Neurologist felt that I have Trigeminal Neuralgia and gave me Elavil.  However, I have not tried this yet, since I may be pregnant.  I have tried electrical stimulation on the back of my head/neck, which was very sensitive on the left side only. I also had a nerve block done yesterday, which had no positive effect.
I am unsure whether this is a Neuralgia, migraine, both or something else.  I have family in Cleveland ( my brother-in-law practices anastesia at Loraine Community Hospital) and would gladly come to Cleveland, if you think you can help.
Sincerely,
Roslyn    




Dear Roslyn:
Sorry to hear about this facial pain.  I was happy to hear that you had an MRI as we do worry about MS in young females.  Your symptoms really do sound like trigeminal neuralgia.  Actually the first line therapy is carbamazepine with alternative medications of phenytoin, clonazepam, baclofen, and pimazide.  The tegratol does work the best but you should find out if your pregnant yet, simple blood test.  Actually, we really stay away from the TCA in this type of pain, but I guess various physicians have their own way of treating.  The literature says that the earlier treatment begins, the better the prognosis for favorable outcome.  I would say to start early, first by getting a pregnancy test and if negative then pursue the first line therapy.  There is no ear pain is there?  We also like to rule out Ramsey Hunt (varicella infection).  I hope your facial pain get under control.
Sincerely,
CCF Neuro[P] MD









Follow Ups:


Change in Headaches - Neuralgia? Roslyn 4/13/1999
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Re: Change in Headaches - Neuralgia? HI ROSLYN 4/15/1999
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Change in Headaches - Neuralgia? Roslyn 4/23/1999
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Change in Headaches - Neuralgia? Karen 4/03/1999
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Re: Change in Headaches - Neuralgia? Mark 4/06/1999
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Change in Headaches - Neuralgia? Thanks Mark from Karen 4/06/1999
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