Re: atypical facial pain

Posted By CCF Neuro MD on September 27, 1997 at 11:50:39:

In Reply to: atypical facial pain posted by nancy on September 24, 1997 at 14:15:25:







: For 15yrs. Ive had face pain(called atypical facial pain, maybe a rare form of CPH?) and
been to 18 different docs. Had mri, ct scan, teeth all tested and many more tests, all neg.
Many meds which didnt help, got Predinson(sp.) poison after 5mos. on 60mg.a day.
It seems to come around every 3yrs., lasts about 2-3 months but last time 1yr. Usually
wakes me or first thing in the morning, usually once a day. It is along the nose, across the
face under the eye, into the temple area and last cycle has also moved up from temple
area into part of the scalp.It even SWELLS as high up as along side of eye.NO eye pain.
Usually lasts 1hr.45mins., but can up to 4hrs. The muscle in those areas is tight as a
drum, SWELLS, like a leg cramp, ONLY in the face! The last cycle of pain, we think,
was stopped with steroid injections up my face. But that has caused other health
problems. Since the last cycle Ive been on Neurontin 1200mg., Indomethacin 150mg.
and was on Zoloft, part of the time, to try to keep the next cycle away. I went to have the
nerve operated on but they couldnt help me because Im atypical. Ive never heard of
anyone having swelling?
Swelling of face and neck?
Any suggestions?






  
I apply ice to the area but all it does is cool the outside. I relax my face and dont move.
What pain medication would act fast to stop the 1hr.45mins. attack and leave system in
short time frame? 2 Peroset (sp.) doesnt stop the pain.
When the muscle lets up...it is the greatest feeling in the world!
Is the diagnoses as good as I can get?
Thanks for your website!







Hello, Nancy,
  Sorry to hear that you have been suffering from this rather complicated condition for this many years.  As you are aware, there are many conditions that can be accompanied by unilateral (one-sided) facial pain.  The ones concerning neurologists the most are temporal arteritis (inflammation of face arteries), trigiminal neuralgia, and atypical migraine headaches.  Each of these has a set of clinical presentation.  For example, temporal arteritis tends to affect elder women, cause high sedimentation rate, and response to steroids; trigiminal neuralgia brings up episodic unilateral facial pain and tegretol is the first drug to try; and atypical migraine has a history of migraine from teen age, and can be precipitated by sweets, coffee, and stress.  In addition, some central nervous system processes may have facial pain as a part of or the initial symptoms.  However, swelling would be an uncommon finding with any of these conditions.  Normal MRI and CT scans, as in your case, would make a central process unlikely.  Swelling warrants a vescular and rheumatology evaluation.  Given your history, I think you should be seen by a neurologist and a pain specialist.  This can be easily accomplished at our department.  Please call toll free at [phone] ext. 45559 for your appointment.
This information is provided for general medical educational purpose only.  Please consult your physician for the diagnostic and treatment options of your specific condition.