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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6188
Experience:  14 years as clinician in the field of Family Practice
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My husband (47yrs, 240lbs and other than this relatively good

Resolved Question:

My husband (47yrs, 240lbs and other than this relatively good health) has pain on the right side of his face along the cheekbone and sometimes travels up to his ear and around his eye. He has been checked out by his oncology doctor (lip cancer 3yrs ago - he is now cancer free). The cancer doctor ran xrays and also ordered a CT Scan all of which have come back normal. He has been checked out by his periodontist to make sure none of the cleaning they did a month ago triggered something - they also ran xrays and they came back normal. This pain is so excrutiating that he has not been able to sleep more than 2hrs each evening. He has also had to take oxycodone every 4hrs to try to relieve some of the pain so he can get back to his regular life and the pain medicine isn't really touching the pain to allow him to do this. I know its only been 10 days but it has been an incredibly long ten days for a man to go without sleep. Any suggestions or direction for help?
Submitted: 6 months ago.
Category: Health
Expert:  Anthony Bray, MD replied 6 months ago.

Anthony Bray, MD :

Hello!

Anthony Bray, MD :

It sounds that he probably has a condition called Trigeminal neuralgia (of the opthalmic branch it sounds..)

Anthony Bray, MD :

This may have different causes but I would advise that he consult a neurologist...

Anthony Bray, MD :

Tegretal is sometimes used to help this specific type of neurogenic pain...

Anthony Bray, MD :

(Other helpful options that may help in addition to narcotic pain meds may be Lyrica, Neurontin, Cymbalta...)

Anthony Bray, MD :

I have had patients rarely whom with this condition had undergone gamma ray ablation to help... (this is not the most typical approach to this problem however..)

Anthony Bray, MD :

The trigeminal nerve has a large ganglia which may at times be subject to viral infection or some cause of inflammation or compression...

Anthony Bray, MD :

An MRI of the head may be of help diagnostically...

Anthony Bray, MD :

Herpes Zoster + shingles can be a cause of pain in this nerve distribution at times...

Anthony Bray, MD :

Herpes simplex one may at times be a cause...

Anthony Bray, MD :

Either of the latter two would potentially benefit from anti-viral treatment such as Valtrex or Famvir.. This would usually need to be early in the course however...

Anthony Bray, MD :

I hope this information is helpful for you!

Customer:

Why would the CT scan not pick up on this nerve especially with the contrast? Will this "go away" as quick as it came on? We thought he had a sinus infection (allergies) and OTC meds were helping and then overnight he was in such pain and now we are 10+ days into this with no explanation from any doctor.

Anthony Bray, MD :

CT scan is not as senstive and lacks the degree of resolution possible than with MRI...

Anthony Bray, MD :

MRI is better test for certtain applications...

Anthony Bray, MD :

I would advise that he consult neurologist though... specifically ask about Trigeminal neuralgia s possible cause...

Anthony Bray, MD :

I think that will help you make some forward progress with the problem...

Customer:

Thank you.

Anthony Bray, MD :

You are very welcome!

Anthony Bray, MD :

I hope that he feels better soon!

Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6188
Experience: 14 years as clinician in the field of Family Practice
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