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Re: atypical facial pain
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Re: atypical facial pain

Posted By ccf neuro M.D.* on May 15, 1998 at 23:07:40:

In Reply to: atypical facial pain posted by chris on April 29, 1998 at 22:32:26:






Through reading, I know I don't have trigeminal neuralgia, but one of my many symptoms sounds like "atypical facial pain".  My other varied symptoms have cleared up over the past several months, and I never had a diagnosis of anything.  My biggest problem is this facial pain.  It is constant, chronic, and is around my jawline and sometimes into my upper neck.  It isn't nearly as bad some days as others.  My questions are, what type of disorders typically involve facial pain as a symptom?  I am being evaluated both for MS and connective tissue disorders, with elevated antibodies, and no other lab findings.  THis facial pain was going on at the time of brain and spinal MRI, but nothing was found.  Antidepressants helped some, but made me way too sleepy.  Are there any other treatments for this?
Thank you.  Chris
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Hello Chris,
Atypical facial pain is what we sometimes in medcicne refer to as a "wastebasket" diagnosis, meaning in this particular case any type of facial pain that is not trigeminal neuralgia, or some other discrete form of facial pain due to damage to a specific nerve or brain structure. Many physicians will order a brain MRI to exclude the possibility of such damage due to a tumor or other neurological disease process. like multiple sclerosis The trigeminal nerve, or 5th cranial nerve, is the nerve responsible for sensation to the face, but does not supply sensation to the neck or head. The drugs typically used on atypical facial pain are those used to treat trigeminal neuralgia, but the success rate of treatment is typically much lower. Carbamazepine (Tegretol) is the usual first drug tried for trigeminal neuralgia, and is sometimes effective in alleviating atypical facial pain. Other anticonvulsant drugs like phenytoin (Dilantin) or gabapentin (Neurontin) are other similar options. Other classes of drugs used to treat such chronic pains include tricyclic antidepressant drugs like amitryptiline (Elavil) and nortryptiline (Pamelor). All drugs in this class have multiple, often annoying side effects including sedation for many of them, and may be poorly tolerated in some individuals. A certain proportion of people who have atypical facial pain will go on to develop classic trigeminal neuralgia in the future. If you would be interested in an evaluation for your problem at the Cleveland Clinic, our number is 1-800-223-2273 extension 45559. Please remember that the information provided on the forum is intended for  general medical informational purposes only, and that the actual diagnosis and treatment of your specific condition should be strictly in conjunction with your treating physician(s).

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