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Dr. B.
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Category: Medical
Satisfied Customers: 7826
Experience:  Physician with 8 years of experience.
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Sluders Syndrome - How exactly is the test performed that

Customer Question

Sluder's Syndrome - How exactly is the test performed that can verify Sluder's Syndrome or similar syndrome? Specifically, there is a nerve in the nasal passage that triggers intense, very prolonged migraine headaches that can last days. In my case, it is 25/7. An ears-nose-throat specialist stuck a long thin metal rod the thickness of a paperclip deep into my nose, and irritated the nerve. It caused my eye to tear up, and pain in my upper face on that side of my face ONLY.

But what I had read is that cocaine should be applied to the nerve ending, and the migraine should subside. Now the doctor 'confirmed' the nerve was a primary cause of the migraines based on his test.

But was the test performed correctly? Or should the test involve applying cocaine to the nerve ending, and the migraine subsiding? Are both methods correct, or is one? Any medical papers I have seen on the internet say the migraine should subside - not intensify and my eye tear up.

Your help would be VERY much appreciated. I am in pain 24/7 and need answers.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. B. replied 3 years ago.
Chat Conversation Started
Dr Sumit Bassi :

welcome to just answe

Dr Sumit Bassi :

what kind of pain do you have?

Dr Sumit Bassi :

did it get worse after the test?

Dr Sumit Bassi :

what testing did he do?

Dr Sumit Bassi :

any other medical problems/

Customer :

hi

Dr Sumit Bassi :

what medicines are you taking?

Customer :

pain is one side of my face - behind my right eye and to the temple

Dr Sumit Bassi :

constant or comes and goes?

Customer :

i also feel congested however specialist told me my breathing is just fine so something is making me feel it is congested

Dr Sumit Bassi :

does it have a regular timing? does it come in cycles?

Customer :

pain is fairly constant - doesnt generally go away

Customer :

i have had different prescriptions over the past 7 years

Dr Sumit Bassi :

other than tearing do you have facial swelling or blushing ior sweating?

Customer :

gabapentin was working the best, XXXXX XXXXX dosage steadily increased until side effects were not worth it - difficulty concentrating so i couldnt remember how to get home from work

Customer :

i have eczema around my nose but no swelling

Dr Sumit Bassi :

any runny nose?

Dr Sumit Bassi :

do they get worse in cycles?

Customer :

ive treated the eczema with .5% corticosteroid

Customer :

not usually runny nose but i do have irritation inside due to botched surgery for deviated septum

Dr Sumit Bassi :

thanks for the propmt replies

Customer :

its worst in the mornings - i lay in bed for couple hours before pain is down so i can get up

Dr Sumit Bassi :

based onwhat you have described up above i gather that you have sluders syndrome which is also called a cluster headache

Dr Sumit Bassi :

these are vascular headaches

Customer :

it is my belief i may have sluder's syndrome or very similar

Dr Sumit Bassi :

the pain is becaue of dilatation of the blood vessels

Customer :

i asked my doctor to refer me to a specialist to have test for sluders

Customer :

specialist did a test, but i feel it may not have been done reliably

Dr Sumit Bassi :

it produces pressure on the trigeminal nerve and hence you have symptoms like tearing if the eye runny nose etc

Customer :

mostly pain is of the eye and behind the eye - one side only

Dr Sumit Bassi :

what test did they do?

Dr Sumit Bassi :

did they do a pet scan?

Customer :

thin metal rod thickness of paperclip - several inches inside my nasal passage on right side - stimulated the nerve

Customer :

caused my right eye to tear up, and intensified pain

Dr Sumit Bassi :

alright sir

Dr Sumit Bassi :

now to diagnose you can use many triggers

Customer :

problem is, my understanding of the correct test is to apply cocaine on a swab and apply to nerve ending and migraine should dissipate

Dr Sumit Bassi :

yourphysician used a trigger to bring about the affects

Customer :

it did intensify the effects... but wouldnt irritating the nerve ending on a normal person also cause pain and tearing on one side?

Dr Sumit Bassi :

you can also use medications and certain foods like chocolate can also bring upon this headache

Dr Sumit Bassi :

this is a clinical diagnosis

Customer :

if i press on the bone just below my right eye, it alieves the pain temporarily - thats about the only physical trigger that helps

Dr Sumit Bassi :

please see a neurologist and ask them to check a pet scan while you are having the headache

Dr Sumit Bassi :

they will see certain areas light up where the blood vessels are dialted

Dr Sumit Bassi :

this is th emost speciic test

Customer :

i have the headache all the time - otc pain medicine helps temporarily

Customer :

but i have to change the medicine every couple months at best

Dr Sumit Bassi :

however like i said before it is a clinical diagnosis and based on the information you gave me it seems the most likely diagnosis

Dr Sumit Bassi :

i will recommend to still get a physical exam and pet scan at the time of attack

Dr Sumit Bassi :

i understand

Dr Sumit Bassi :

the treatment is also focused at one first when you have an acute attack and then second as prophylaxis to prevent more attacks

Customer :

my question however is whether the test i received is conclusive, or should i request a second test to numb the nerve and see if the migraine subsides

Customer :

the specialist is planning surgery on the nerve

Dr Sumit Bassi :

typically over the counter pain medicines do not help much in an acute attack

Customer :

i just had a ct scan

Dr Sumit Bassi :

in my opinion this test is not necessary to be repeated

Dr Sumit Bassi :

pet scan is different

Dr Sumit Bassi :

they use a sugar to look for brain activity

Customer :

if i understand correctly, you suggest a pet scan rather than the general sluders syndrome test with cocaine applied to the nerve ending

Dr Sumit Bassi :

to abort an acite attack you can use medcines like sumatriptan , hyperbaric oxygen, topical local anesthetics

Customer :

ive tried the triptans - no effect - as for topical anesthetics, the specialist basically said that was what he applied to the nerve ending

Dr Sumit Bassi :

yes if you want to confirm diagnosis but like i said before it is a clinical diagnosis and your symptoms seem most likely cluster headache

Dr Sumit Bassi :

you need to spray the nasal cavity with the topical anesthetics and that should take care of it

Customer :

thank you - yes it has been diagnosed as a cluster headache previously but it is now suspect to be sluder's syndrome or similar - nerve based

Customer :

i am hoping to find out the specifics of which test should be utilized to determine whether surgery is necessary - ie severing the nerve

Customer :

Please note, I am not seeking a diagnosis. As per the heading of my question, I am requesting to know exactly the method of performing the test for Sluder's Syndrome, and specifically if the test I have already had is the right test to be absolute about Sluder's Syndrome or similar nerve induced migraines. But thank you for your time.

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