Re: Facial/ ear/ throat/ scalp burning pain..
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Posted by CCF neuro M.D. on May 25, 1997 at 11:10:41:
In Reply to: Facial/ ear/ throat/ scalp burning pain.. posted by Nancy Snodgrass on May 13, 1997 at 15:48:52:
: Had pneumonia in January, also had burning in ear and on face, thought it was part of the pneumonia. (also had costochondritis on the right side) Or, I thought perhaps it was the 3rd recurrence of shingles in 2 years. In Feb, the pain in my face (BURNING, scratched, throbbing, unbearable) was diagnosed as TN, even though I have never had "short electric-shock like bursts of pain" Mine develops slowly and increases in intensity over a period of hours. COmplete horizontal rest and heat/ice packs help. Usually an episode goes away after a full sleep. My MRI showed no compression, only "inflammation". I am wondering, QUESTION 1) Could this inflammatory condition be a result of a virus affecting the cranial nerve causing the burning pain (it has become worse in my ear and throat over the last 2 months, EVERY DAY) Could it be the result of a virus since I had pneumonia when this appeared -- or could the problem be caused by a fungal infection in the nerve? I am plagued with systemic fungal infections for which I have to take 10 days of Diflucan a couple of times a year. I know i have a fungal infection when ice cream, cheese, milk, sugary things and vinegar-based foods (also cigarettes) cause my mouth to taste bitter and feel parched and my tongue becomes white. These same items cause the ear/throat pain that has become so bad. I am intolerant to the Tegretol-Neurontin-Baclofen drug-go-round. Before I go back to my doctor I wondered if a virus or other infection could be the cause. Also -- I went painfree for 3 days, without speaking, or eating solid foods, keeping a poker face. QUESTION 2) Would resting this NON-compressed, inflamed nerve help it to go away, perhaps?
I also have had shingles, costochondtitis and a stuffy sinus on this side of my body this year. Now, with the facial pain and ear/throat burning, I get a headache that travels from eye over the top of my head down to the occipital area. (Also had a twitching right eye for 2 weeks straight). I have an absent-minded habit of scratching the top of my head while reading or watching TV, could THAT habit have irritated the craniall nerves? I have just now cut out coffee and cigarettes. I quit drinking colas a month ago. All these things bother the pain, as does a fan blowing on my cheek, and putting makeup on a certain spot just under my cheekbone. Any advice is welcome -- something I can take to my doctor. I don't want surgery, don't really believe I need it. I am 42 years old and have had a stressful couple of years, otherwise I am healthy except for allergies, for which I take weekly antigen shots, 3 years now.
Nancy, Your question is too long and complicated to possibly address every issue you have raised. Recurrent fungal infections (especially oral thrush like you describe), recurrent shingles, and very strange neurologic symptoms are often all signs of underlying undiagnosed HIV infection. If you have not been tested in the past 6 months for HIV, I would strongly suggest you have this done. Although certain causes of chronic infectious meningitis like fungal or tuberculosis-like bacterial infections can present with damage to multiple cranial nerves, usually most or all of the function of such nerves are affected and symptoms include numbness and weakness of various parts of the eyes or head, not pain. Just the ear alone receives sensation fibers from three different cranial nerves--- for all of them to simultaneously generate p[ain in the slow progressive manner you describe as a result of a fungal or any other infectious or inflammatory process is extremely improbable. If your shingles involved your face or ear, you could have a problem known as post-herpetic neuralgia, a chronic, burning, persistent pain in the distribution of the nerves previously infected by the Varicaella viruses that caused the shingles in the skin areas they supplied. This is an extremely stubborn, difficult to treat problem that may persist months to years. Your symptoms are not compatable with a diagnosis of trigeminal neuralgis in my personal professional opinion. If you do not have HIV or post-herpetic neuralgia or chronic meningitis of some sort (a spinal tap is a good test for this), your pain would fall into a category called atypical facial pain, which does sometimes evolve into trigeminal neuralgia. In addition to the medications you have tried, tricyclic antidepressants like amitryptiline, nortryptiline, doxepin, or desipramine for examples, often help alleviate such pain. The doses used for pain relief are typically much smaller than those used to treat depression, although if you feel stressed and/or depressed, you may be able to kill two birds with one stone by using the higher doses. This requires drug level monitoring. Again, I cannot emphasize enough to you the distinct possibility of underlying HIV infection and would suggest that even if you have had the antibody test that you go one step further and have additional blood tests to look at your CD4 cell count and for HIV virus antigens, as some people infected by HIV have such damaged immune systems that they cannot manufacture enough antibody to turn the test positive. A final possibility I should mention to you is a condition called hemicrania continua, where an entire half of a usually young woman's head constantly hurts. This specific condition responds only to a particular antiinflammatory medication called indomethacin. If you are interested in a neurological evaluation at the Cleveland Clinic, our number is 216-444-559 or 1-800-223-2273 ext. 45559. Any of our neurologists would be able to see you for this type of pain problem.
the higher dose, provided you can tolerate the side effects.