Trigeminal Neuralgia

[Pam]

I have an appointment with an Internal Medicine Doctor on Thursday.  I have had a very rough two months with severe episodes of pain in my face, ear, teeth, temple and jaw.  Finally I felt my medical doctor believed me, and he refered me to the Internal Medicine Doctor after prescribing Tegretol which has helped with the pain.  I have slept two nights in a row.  My question:  does laying down trigger TN?  15 minutes after laying down, I have a severe pain episode.  Another question:  Will I ever feel I can think clear on the Tegretol? I can barely get through this question, but I have only been on it for two days.

Thank you,
Pam

[CCF Neuro[P] MD, RPS]

Dear Pam:

I am not sure of your dose but if you have just started tegratol, then many people have a similar reaction to it when first started on it.  After a few days things should calm down and you should be able to function as you did before the facial pain.  What you describe is not uncommon.  It usually arise from the fact when you lie down, you stop thinking about the events of the day and suddenly you notice the pain or throbbing.  As the tegratol kicks in, you should notice less and less of this at night. If the cloudy thinking continues for a few weeks tell your physician and there are other medications that will also ease the pain.

Sincerely,

CCF Neuro MD

[tracey]

On july 1 st i suffered an occular migraine.  I have had these before(4 in the last 6 yrs)  the difference this time was that I did not regain full vision in my left eye.  Have seen a nuero-opthamologist at Mass Eye and Ear.  Had and MRI with contrast dye(normal) a flourecein angiogram(normal) and blood work-sed rate was 50 on july 19 but is now normal at 22.  All other blood work is normal(CBC,ANA, immunoglobulin etc)  Docs think that I had a migraine with prolonged aura and that my vision is now ireversible.  (All eye exams normal-retina, optic nerve)  Since this happened i have had other symptoms-head pain in left temple since occurance, in left side of head and at base of head.  numbness and tingling which started about 4 weeks after event-all left sided-facial pain in eye socket, ear and upper left teeth.  Docs are glad that tests coming back negative but are at a loss to explain pain and nueralgia.  This is the thing I was diagnosed with a patent foramen ovalea in 1997. I have a right to left shunt at rest(echo was not a treadmill)  Docs are looking at endocarditis(blood cultures came back negative) My nuerologist has precribed 2 adult apspirin a day.  My question is if nothing was seen on the MRI or flourecein what could they be looking for-I know the aspirin is an anticoagulant but if my heart is sending off emboli wouldn't the damage be seen on an MRI especially since I have vision loss-I am a 37 year old female with no other risk factors except I am overwieght and probably have an elevated cholesteral count-last year I had a count of 207. Please help all this talk about the patent and stroke is very upseting to me---Why after 35 years and not knowing it was there I would have problems now??   Should I have it closed???  Noone  in the past 2 years has suggested it to me not even the cardiologist.

[CCF Neuro[P] MD, RPS]

Dear Tracey:

A stoke event would have been picked up on MRI, especially the T2 weighted and FLAIR images.  You might have had trigeminal neuralgia as your sedimentation rate was up.  Without examining you I can't say for sure.  About fixing your heart, if you have no right-to-left shunting of blood through the foramen ovale you wouldn't need to have the patent foreman ovale fixed.  If you do have this shunting problem, it might be a good idea to see a cardiologist about getting it closed as you have multiple risk factors for a stroke.  Talk things over with your neurologist.  It is difficult to answer your question about why.  There are things that can give you symptoms as you describe and many of them can be diagnosed by MRI and eye exam.  

Sincerely,

CCF Neuro MD