spenopalatine neuralgia

I have been experienceing "noseaches" for over 15 months.  Started with sinus infection, when that was over started with tingling throbbing pain across my nose, tooth, nostril, eye on one side.  When I lie down its much worse and my nose gets stuffy.  I have been treated with various nasal steroids and allergy meds.  I have tried narcotics, prednisone, 4 different antibiotics, had surgery for deviated septum, occipital nerve blocks, amitriptylene, gabapentin, imitrex, topamax, cymbalta, I could go on.  The only thing that has helped has been the prednisone and obviously I can't take that long term.  I have seen 4 ENT, 4 neurologists, primary care, allergist, had ct scan and 2 MRIs done with no abnormalties.  I read about sphenopalatine neuralgia and I see myself.  I would like to be referred to a specialist in this treatment.  I am now involved at a headache clinic even though I repeatedly say I don't have a headache.  I understand that there is a test or treatment involving lidocaine dripped directly on the sphenopalatine nerve.  How do I get to the right specialist.  More importantly, do my symptoms sound like this syndrome.  I plan to explore this more with my doctor which is 12 days away.

[dr_simran]

Hello Dear,
Sphenopalatine neuralgia is defined as-
Neuralgia of the lower half of the face, with pain referred to the root of the nose, upper teeth, eyes, ears, mastoid, and occiput, in association with nasal congestion and rhinorrhoea occurring in infection of the nasal sinuses, and produced by lesions of the sphenopalatine ganglion; ocular hyperaemia and excessive lacrimation may occur.

The pharmacologic management may be divided into abortive/symptomatic and preventive/prophylactic strategies. Abortive therapy is directed at stopping or reducing the severity of an acute attack, while prophylactic agents are used to reduce the frequency and intensity of individual headache exacerbations. Due to the fleeting, short-lived nature of the attacks, effective prophylactic therapy should be considered the cornerstone of treatment. The prophylactic therapy should start at the onset of cycle and continue until the patient is headache free for at least 2 weeks. The agent then may be tapered slowly to prevent recurrences
Abortive agents- High-flow oxygen
Ergot alkaloids- Ergotamine (Cafatine, Cafergot, Cafetrate, Ercaf
Anesthetics Intranasal lidocaine 4% Xylocaine .
Local anesthetics stabilize the neuronal membrane so the neuron is less permeable to ions. This prevents initiation and transmission of nerve impulses, thereby producing the local anesthetic action .
Surgery is considered if there is no improvement.You should consult a neurologist for evaluation.
Refer http://cancerweb.ncl.ac.uk/cgi-bin/omd?Sluder's+neuralgia
http://www.emedicine.com/neuro/TOPIC70.HTM

Best

[susanky2]

I am interested in the lidocaine treatment.   What specialist does the lidocaine nerve block for sphenopalatine neuralgia, that is, if that is what I have.

[dr_simran]

Hello  Dear,
Lidocaine  blocks conduction of nerve impulses by decreasing neuronal membrane's permeability of sodium ions, which results in inhibition of depolarization and blockade of conduction.
Intranasal administration of lidocaine drops requires specific and, for many patients, difficult technique.
The dose is 4%solution intranasally.
Used  with  extreme caution in patients with marked hypoxia, severe respiratory depression, or bradycardia

Not much is documented about this therapy ,it is an experimental abortive therapy,you should consult your neurologist about the side effects before going for it..
Refer http://www.emedicine.com/neuro/TOPIC70.HTM
Best

[susanky2]

Is this a treatment (or test) that uses tubes with the lidocaine or is it an injection?  I thought the tubes had been used for quite sometime?

[sfw81]

Hi,
I have had this type of pain almost constantly for over a year following pressure trauma and subsequent anaerobic sinus infection while doing marine research involving intensive SCUBA diving.  I had the lidocaine block as a diagnostic test to indicate that I was a good candidate for sinus surgery, and would not recommend it as a long-term treatment or solution.  The lidocaine made the pain in my nose, right eye, and upper teeth disappear almost instantly, but also made it hard for me to breathe or swallow for almost two hours afterwards.  It made me nauseous as well, and the pain came back as soon as the lidocaine-saturated cotton was removed from my sinus cavity.  I've tried every treatment you listed, and nothing has helped except narcotic pain relievers. I've also read that alcohol injections through the soft palate into the ganglion might work, so I'm trying to find someone who does that.  Good Luck!

[daniellevmt]

I too was diagnosed with Sluders by having a lidocaine-soaked pledget applied between the contact point.  I have a deviated septum with a spur, and the spur is in constant contact with the turbinate (and nerve bundle) on the opposite side.  So I am in pain almost all of the time.

I am making my appt. for surgery this week and am hoping that this cures my horrendous facial pain.  This is no way to live.  I have to laugh when medicine says, "well, we don't know if sluders really exists".  HA!  Yeah, when a doc can squirt some local anesthetic on a piece of gauze, shove it up my nose, and take away all of that horrendous pain that quickly???  Yeah, I think it exists, Einsteins!  TALK TO YOUR PATIENTS!

So as to the previous poster asking about lidocaine therapy, it works, but it only works short term.  For me, an hour or two.  I also find that it's not really working at all for me anymore.  It's like it lost it's efficacy after doing it so many times.

[SANDYLOULOU]

hi i suffer from same conditions for 10 years now, resulting from undiagnosed zoster, i now take Marinol which helps me a lot, only concern is that i am going back to Europe and it is not legal there so i am unsure what they will give me then.:((