I have severe muscle spasms only on the left side of my face associated with left side head pain, similar to an earache and sharp headache pain. I was originally diagnosed with Dystonias by a neurologist in the hospital, but feel this is muscle related from my neck from past problems. I had gone several weeks with no problem, then it started again. I have taken Baclofen with no significant help. The spasm pulls from my mouth on the left side and subsequently makes my jaw sore also. During the contraction I am unable to speak. Usually, I have the head pain when not having the spasms. The spasm seems to release tension and for a brief time there is no head pain. What can I do differently or what type of doctor should I see?
Gender: FemaleAge: 47
Chiropractic, Baclofen, over the door traction (2lbs)
Greetings and Welcome to JA! I am sorry you are going through this, let me opine.
How long has this been occurring?
I was originally diagnosed June 20, 2009. Symptoms subsided after a couple of months and actually disappeared for several weeks only to return several weeks ago
Your history does sound consistent with dystonia. The problem is, dystonia can lead to torticollis where the neck gets stuck in that position. Therefore, adquate treatment is necessary. Continue traction and massage - those are important.
When my patients fail baclofen, I try meds like benztropine or trihexyphendityl for acute spasm attacks. For control, I will sometimes start carbidopa-levodopa to see if this helps. If it doesn't, I will often use botox injections to the muscle every few months to keep the spasms down - this works very well but requires repeat injections so I save it as a last resort.
These are a few options you can discuss with your doctor.
How is the tightness and pain in the muscle in my neck related if it is a virus affecting the nerves?
Sometimes viral infections can exacerbate the dystonia. It's not that the virus causes it, but rather the acute stress on the body and the flux in the immune system allows the problem to come out. This happens often and that's why I give most of my patients with dystonia some meds to keep at home for an acute attack.
For further evaluation, which type of doctor is recommended? I currently have no insurance and no primary care, but am willing to see a specialist if they will take me without referral
A good primary care doctor should be able to manage this with you but they may not feel comfortable doing so. Also, if you tell this doc you can't afford a specialist, this may make them more apt to manage this with you.
If not, you need to be seen by a neurologist. Many specialists will see cash paying customers without needing a referral. If, however, you plan on using the county free insurance (available on some counties), you will need a referral.
One last thing please. The other medications you recommended, are these muscle relaxers also? Also, can you tell me why weight training seemed to have helped initially, but not this 2nd time around?
not a problem.
No, they are not muscle relaxants. The first two work via the dopamine and serotonergic pathway to alter muscle activity.
The third is actually a parkinson's med which helps with these symptoms as well.
Weight training helps the muscles invovled but also helps the unaffected muscles. Muscles are like ying/yang. There is an opposite for each muscle. So weight training increases the strenth of the opposite muscles to help avoid the spasm muscles from spasming. Like if you pull a on a tug of war rope very hard and beat me, then I work out and pull back, we may stalemate.
UW Med School/UCLA Training/USC Faculty. Full Spectrum Family Medicine - Adult, Peds, OB/GYN