facial sensations

[cat962]

i am 58 year old female recently i have mri with/out contrast normal b-12 test normal emg normal ana norma sed rate normal protein something normal and have ruled out all the bad thing -- i have facial sensations that feel like i have icy hot on it from the middle of my face to the left with a pulling sensation this comes and goes but lately it comes-
saw my pcp and neurologist thinks it may be something benign and it will clear advised taking neurontin.. i do have spinal stenosis in the cervical spine and tmj can someone give me some insight to this sensation

[Esteban Cheng-Ching, MD]

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 your doctor.
Without the ability to examine you and obtain a history, I cannot give a diagnosis, however I will try to provide you with information.
It is very good that all the tests you mentioned are normal. Regarding the symptoms that you have, they sound like a neuralgia, and more specifically a trigeminal neuralgia.  Without being able to get a detailed history an examine you I cannot give you an exact diagnosis. Trigeminal neuralgia is pain that presents in a paroxysmal fashion in the distribution of the trigeminal nerve (frontal region, maxillar region and mandibular region). It may be ranging from mild to severe, and episodes may be associated with triggers such as chewing, talking, brushing teeth, cold air, smiling, and/or grimacing. Imaging studies (such as the brain MRI) are important to rule out structural causes of this condition.
If no structural cause is found, treatment is with medications. Medications used for this include Carbamazepine, Phenytoin, Oxcarbazepine, Pregabalin, Neurontin, and others used for other conditions such as epilepsy or seizures. The medications reduce the frequency and severity of episodes, however the symptoms usually recur, and rarely they do disappear completely.
Spinal stenosis should not be causing symptoms in your face.
Regarding TMJ, many patients with TMJ problems present with facial pain, and by treating the TMJ the facial pain improves significantly, so it may be important for you to discuss with your dentist or oral physician, how will be the best treatment for your TMJ, and if this is causing your facial pain.
Unfortunately as I said, without being able to obtain a detailed history and physical examination as well as neurologic examination, I cannot tell you what the cause of your symptoms is.
I think you should discuss your findings with your neurologist, as well as the physician who is managing your TMJ, in order to determine if there is other cause for your symptoms, and treat it accordingly.
I hope you get better.

[laaz]

Have you ever heard of immune mediated small fiber sensory neuropathy?  I was diagnosed wih this 6 yrs. ago.  Does a small fiber neuropathy ever go away or heal itself?  My symptoms started with a jab of pain up inside my nose after the flu or viral infection. Now I have vasomotor rhinitis.  And after the jab up inside my nose,  a few days later I had a huge wave of pricking sensations all over my entire body. Leaving me with the most horrid unusual senations all over my body especially my face. Buzzing , cold water like sensations etc.  Are the nerve endings up inside your nose periperal nerves??  Why would a jab feeling inside cause non allergic rhinitis and also these whole body sensations.  This is enough to drive a person crazy and make for a terrible miserable life and probably never going away.  I have always been healthy and never sick, but I did get sick with the flu after a vactation to the Dominican Republic.  Please give me as much insite on my problems as you possible can.    Thank you in advance.  Laaz