Sensitivity of skin on head and neck.

Over the past couple of years, I have been having more frequent episodes of sensitivity of the skin on one side of my head and neck.  It starts with a feeling of malaise.  I will just not feel good.  I feel kind of achy and I just want to rest.  Then, within a few hours,  I will start noticing that my skin is becoming more sensitive.  The whole side of my face, my eye, my jaw, up through my scalp will be very tender. Then, I will get shooting pain through my jaw and up through my ear. Sometimes, I will even get a sore on my gums.  This happens on both sides, but not at the same time.  It seems to alternate.  I will go a few weeks where I will be fine, and then it will start all over again. After a week or so, it goes away.  At one point, I was told it may be shingles, but it happens so frequently.  Any ideas?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

There are several “common” pain syndromes of the face other than headaches. One is a condition called trigeminal neuralgia. This is a type of pain that comes and goes on one side of the face and is severe and sharp when present. When there is no pain, most people are symptom free. It is in the distribution of the trigeminal nerve, hence its name. The pains are usually on the cheek and jaw regions. It usually occurs in people older than 50 years of age. Triggers can include washing the face, shaving, smoking, talking, brushing teeth, etc. The cause is unknown but the thinking is that it is from compression on this nerve. The diagnosis is largely clinical. MRIs may be obtained to rule out other causes or to attempt to identify a cause for the pain, but these tests are most often normal. Treatment includes medications, such as carbamaezpine, gabapentin, and topiramate, that are used in treating seizures. Many pain medications have indications other than pain treatment. Other options include baclofen or clonazepam. If medical therapy is failed, a referral to a neurosurgeon may be an option for consultation regarding trigeminal nerve decompression or radiofrequency ablation.

Another condition that should not be overlooked is called giant cell arteritis or temporal arteritis. This condition is due to an inflammation in the temporal artery and other arteries in the body. Symptoms include one sided headache pain in the temple and jaw that may be triggered by chewing. This condition can be diagnosed by a blood test called an ESR and a biopsy of the artery. It is very important to rule this diagnosis out since it is highly treatable and if left untreated it can lead to vision loss. It is exceedingly rare in people younger than 55, and is more common in even older age groups.

I recommend that you follow up with a neurologist. If present, these pain conditions are difficult to treat and may take time.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.