Re: atypical facial pain

Posted By CCF Neuro[P] MD, RPS on January 02, 1999 at 12:17:25:

In Reply to: atypical facial pain posted by Jeff on January 01, 1999 at 13:30:29:






I have had pain in the left front sinus area for 17 years.  The pain occurs in the area just below the left cheekbone and radiates from there.  It is a constant dull ache which occurs during appoximatley 75% of my waking hours.  The pain is present every morning when I wake up and also occurs when I am tired.  In addition, the pain makes me tired and causes my eyes to become heavy and sleepy.
I have tried so many treatments I cannot even count them all.  I have tried various medications, including amitryptiline and all kinds of other prescriptions.  I have also tried acupuncture, biofeedback, injections of local anesthetic.  I have been to nerologists, psychiatrists, anesthesiologists, ears, nose & throat specialists, pain management clinics.  I have haad surgery twice to clean out the sinuses, the first time actually using an incision and more recently endoscopic surgery.  I have had X-Rays, Cat Scans and an MRI Scan, all of which are negative.
Can you help me?  Do you know of any knew treatments?  The last anesthetist I went to tried the injections and suggested surgery to cut a nerve.  He sent me to a neurosurgeon who was prepared to operate but could not make any guarantee of success.  There were too many potential problems that could occur without a guarantee of alleviating the pain.
Several doctors have tried to treat the pain as being trigeminal neuralgia or tictelaroo.  In frustration, they have called it atypical facial pain because there is no other diagnosis that fits.
Any suggestions?  I would be grateful for any help you can give me.
Thank you very much.
Dear Jeff:
We treat alot of headaches here at the Clinic.  We have seen several like yourself with this type of cephalaglia type pain.  There is not much in the literature about what to do about it.  One of the experts in this type of headache is at Thomas Jefferson in Philadelphia, Donald Silberberg.  What he suggests is a local injection of pain numbing medication, and if the pain goes away to repeat.  It the pain still remits then it is likely that surgery will have a beneficial effect.  However, there are no guarantees in medicine.  So, I guess what you will have to do is weigh the pros and cons and make a good choice.  I think if it were me, I would want a second opinion from a headache expert and would want the very best neurosurgeon in the area.  Best of luck.
Sincerely,
CCF Neuro[P]