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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 7201
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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I had 12 days of radiation on my head, up from my left temple

Resolved Question:

I had 12 days of radiation on my head, up from my left temple and the doctor said I have nerve damage and put me on gabapentin. So far, the paid just seems to be getting worse. Would neurologist be of any help?
Submitted: 8 months ago.
Category: Neurology
Expert:  Dr. Frank replied 8 months ago.

neuromd2012 :

Welcome to Just Answer. I am an Adult Neurologist and was contacted to answer your question.

neuromd2012 :

hello

neuromd2012 :

waiting for you to come online

Customer:

what other info do you need

neuromd2012 :

hello

neuromd2012 :

so why the radiation, where is this exactly?

Customer:

Skin cancer, basal cell, approx. 5" above my left ear and directly in the hair line.

neuromd2012 :

oh ok

neuromd2012 :

so have you tried topical meds?

neuromd2012 :

like capsaicin?

Customer:

There is nothing to put a topical med on. Treatment was finished in April.

neuromd2012 :

no

neuromd2012 :

you would smear a creme over the area that hurts. I assume it is an area starting at your mid temple, and going up to the vertex of your head? If it is in the hair line, you may not be able to smear a lot of creme in that area

neuromd2012 :

do you have burning Pain?

neuromd2012 :

do you have numbness?

Customer:

Don't understand why it would help. The pain is the size of a man's hand, my eyebrow has sagged and it is all painful to the touch including my eyebrow.

neuromd2012 :

capsaicin is a topical substance P inhibitor

neuromd2012 :

you put it on the nerve end fibers in an area that hurts

neuromd2012 :

it depletes the nerve of all the neurotransmitter to send pain signals

neuromd2012 :

and it stops hurting

neuromd2012 :

you need to cover it daily with a creme, cover the entire area that hurts

neuromd2012 :

the creme will burn when you first use it, until you run out of substance P

neuromd2012 :

and then you will not feel pain from that area

neuromd2012 :

the alternative is to use neuropathic meds like you are currently doing

neuromd2012 :

gabapentin at up to 1800 mg a day is indicated

Customer:

Yes it is a burning pain, wish I had numbness. How could I use it in an area this large. If you put your hand on my eyebrow and fingers into the hair that is the area that the pain covers.

neuromd2012 :

or there are other medications like pregabalin (Lyrica), or duloxetine (Cymbalta)

neuromd2012 :

ok

neuromd2012 :

it would be difficult to cover that area

neuromd2012 :

have you tried a supra orbital nerve block?

neuromd2012 :

let me show you a picture

neuromd2012 :

Full Size Image

neuromd2012 :

if you look at that picture, you will see the nerve as it comes out just above the eyebrow

neuromd2012 :

you numb it with a long acting medication, like marcaine and you get pain relief for a week or so

neuromd2012 :

it that is the right nerve causing the pain

Customer:

no I haven't. Do you think the diagnosis is correct? The radiation area was right above the longest nerve in the picture.

neuromd2012 :

yes,, that is just a drawing, the nerve comes up out of the supraorbital notch, If you feel your eyebrow and work towards

neuromd2012 :

your nose, you will feel a notch in the bone right on the ridge of bone above your eye

neuromd2012 :

that is the supraorbital notch

neuromd2012 :

you can even push on the nerve at that point, and it may change the quality of the pain from the scalp in that area

neuromd2012 :

so the nerve extends back on your scalp all the way to the middle of the top of your head

Customer:

What would the supra orbital nerve block do, what is it?

neuromd2012 :

well at that point on your forehead, just like in the drawing where you see the needle

neuromd2012 :

you inject a combination of steroids (depomedrol which is methylprednisolone)

neuromd2012 :

and lidocaine/prilocaine (Marcaine)

neuromd2012 :

and that will numb up the nerve for a week

neuromd2012 :

if that works, you can use agents like xylene

neuromd2012 :

to numb up the nerve for a longer period

neuromd2012 :

since you have had this for 4 months or so

neuromd2012 :

I don't know if it is going to get better, has it become less intense over time?

Customer:

No, it's becoming more intense expecially above and the eyebrow. Is there ever a cure for this or do You have to learn to live with it.

neuromd2012 :

There are cures

neuromd2012 :

if necessary

neuromd2012 :

you have to see a neurosurgeon that specialises in peripheral nerve surgeries

neuromd2012 :

you would have a neurolysis of the supraorbital nerve

neuromd2012 :

that may leave you with an area of numbness on your forehead

neuromd2012 :

but you would not have pain

neuromd2012 :

that would be an extension of the nerve blocks if they helped

Customer:

What do they do, cut the nerves? I'm 72 and have health issues.

neuromd2012 :

yes

neuromd2012 :

they would cut the nerve and bury the stump in an area under your eyebrow

neuromd2012 :

you may not want that

neuromd2012 :

but alternatively, there is only the shots to block the nerve signals

neuromd2012 :

or the medication, which you said was not helping????

neuromd2012 :

how much gabapentin have you tried?

Customer:

For 12 days and I'm up to three a day. He wants me to go up to five a day and I will but the doctor is a dermatolgist and isn't sure they will help or what the prognosis is. He's never had this happen before.

neuromd2012 :

are they 100 300,400, or 600 mg tabs?

Customer:

300 mg

neuromd2012 :

ok

neuromd2012 :

well you can take it up to around 6 a day, but you should be seeing some improvement if you are taking 3 a day for the last 4 days

neuromd2012 :

you may not see a complete resolution, but some improvement???

Customer:

Thank you for your help although I'm a bit discouraged. I'll find a neurologist in OKC but probably can't get an appt. for 6 months.

neuromd2012 :

I understand

neuromd2012 :

I would suggest a supraorbital block with just lidocaine, as a diagnostic test

neuromd2012 :

to see if you can abolish the pain, if even for a day

neuromd2012 :

then you can consider other options than daily medication

Customer:

Thanks again, I'll let you go now.

neuromd2012 :

ok good luck

neuromd2012 :

bye

neuromd2012 :

Dr Frank T

Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 7201
Experience: Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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