Facial Pain..TN?

[jibjen]

Hello Everyone.I hope you do not mind me throwing this question out to you here. I am from limboland (currently) with no dx. I have had issues in past with migraine and am seeing a nueroligist for past 4 years. I have never posted here before but  have a current issue with facial pain. I have had MRI's in past with abnormalities suggestive of MS. Long Story short

I had an appt. with doc this past Tuesday and discussed a new issue with me. Facial pain. I have facial pain on left side of face with a numb spot on side of nose and on upper left lip. This started about a week before Christmas and I had a burning sensation as well around eye and side of face but numbness was only on those 2 speciific spots..My doc was on vaca at time...This has progressed as it is down my jaw and cheek... I would not wake up with it but after getting ready for work putting makeup on for example and then going out in cold air my face would really hurt..Only left side though ..I told him about this on appt. and he said he does not feel it is med effect, AND I have had no migraines..This is becoming more painful now than initially annoying.

He scheduled me for an MRI. He also did a couple of neuro tests such as follow his finger with eyes, shut my eyes tight and open and the smile test...I don't know what this was for..
He told me if anything neurological happens go straight to ER..He asked me if I had dental issues, trauma or had any dental work done. I have not.


Anyhow..I got the my MRI results which show no chnage from last MRI, no mass, no hemmorage, acute infarct, no restricted diffusion.

hyperintense FLAIR periventricular and subcortical wm abnormality essentially stable in number and size from last MRI
(I have 20 of them)

Thanks guys. Any input would be great. I see him in a week..He also did another Lyme's titer test..
I am sort of bumming there was no change as I have been searching for an answer for almost 2 yrs now

I don't want this pain to be dismissed because MRI is same... How is MRI used if this IS TN

JibJen

[telynn]

This could be TMJ Do you Grind your teeth at night? Will cause Headaches also.

[jibjen]

Thank You...

Jibs

[painterchic]

good idea, get a good set of xrays, have him/her get a good look at the tmj joint, as there can be crossover issues, sometimes causing TN symptoms as well. It gets so tricky in this area and hard to distinguish. Good luck!

[jibjen]

Thanks so much...I am going to make an appt. with dentist also just to ask him to rule out a few other things..I wanna be one step ahead of my neuro at next appt...

[painterchic]

oh and btw, my diagram of TN nerve from Gray's Anatomy is in my photos in my profile.

[painterchic]

First of all sorry to hear you are feeling this. It stinks. You sound exactly like me. I hate going outside because the cold makes my face hurt. Wrap up. It helps. Carry those little hand warmer things with you, they help too. You will find little tricks to make life manageable. You may never find an answer on an MRI I hate to tell you. Most of it is trial and error to get to a dx. A good doctor will be patient and try different drugs to see what works for you. Nancy offers good advice. Find a teaching hospital if you can and at a minimum a neurologist who will listen or try new things. I have found strangely that Topomax helps take the edge off my facial pain for some reason, not your average TN cure but thought I might share since my latest.
The main thing is don't give up. You are not alone. You are not crazy. Keep track of triggers that make things worse for you. Write it down. The drugs make you forget, I promise you.
Good luck in your journey.

[nancy99n]

One last suggestion -- find a large teaching hospital that has a Facial Pain specialist -- that doctor would be able to figure out exactly what your pain is and how to resolve it.  I went through 5 different doctors before I found #6 -- the pain specialist who helped resolve my problem.

[jibjen]

Hi Nancy99n,

Thank You for the info. My MRI report did not say anything about nerve compression..I just says periventricular lesions are stable...

I do not know where it will go from here..It looks like the slices on MRI were thick..I did not have any contrast.

I guess I will just have to wait..I know the pain intensifies as the day goes on especially after putting on my makeup for the day and then being in cold..sometimes when I eat and speak..The jolts are random but have continuous burning and aching..I feel like my face is literally split in 2 with the different feeling..I have no dental issues. I just can't imagine what this will be..It sometimes goes to my chin as well..Maybe it is plain old parethesia
My aunt has TN and said it is miserable..
Thanks for your help.

JibJen

[nancy99n]

MRIs are used to see if there is a blood vessel or vein pressing on the TN nerve.  However, it's the 80-20 rule -- lots of times you may have a TN compression, but it does not show up on the MRI.  MRIs are also used to diagnose MS -- TN and MS can go hand-in-hand.  A good MRI for TN is called a "thin-slice" MRI -- basically they take hundreds of shots of your brain with and without dye.

TN and MS are both diagnosed after everything else is ruled out.  It would be good if you could keep a pain journal, jotting down where it hurts, when it happens, how it feels (burning, stabbing, electric), how long the pain lasts, what appears to trigger the pain, etc.  That would help in diagnosis.

TN is very often mis-diagnosed as a tooth problem.  I have heard horror stories from other people that have had most or all of their teeth extracted, root-canaled, etc -- only to find out it was TN all the time.  This is because the TN nerve has little branches that go to every one of your teeth.  Painterchic has a post on this forum that takes you to the Gray's Anatomy -- it shows where all the branches of the TN nerve goes -- pretty much your whole face -- the eyes, the nose, the jaws...

Anti-seizure meds are used to stop the TN pain, if that's what it turns out to be.  These drugs need to be slowly increased until you reach the level where the pain stops.  (Speaking from my own experience, both my internist and my MS neurologist knew enough to prescribe the drugs, but did NOT know enough to increase them -- took me 3 months to find a facial pain specialist who knew how to treat TN!)

Best of luck -- I hope it's not TN -- TN is not a pleasant disease.  And if it is I hope your doctor is knowledgeable and can help you out!