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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 8999
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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My mother has Trigeminal Neuralgia and has had acute pain in

Customer Question

My mother has Trigeminal Neuralgia and has had acute pain in her head for sometime.
She has had it for sometime but the head pain is getting worse.
Can you tell what the symptoms of this are and what is best used to treat both it and the pain?
Submitted: 7 months ago.
Category: Neurology
Expert:  Dr. Frank replied 7 months ago.

Can you tell me about the head pain? What do you mean exactly, this is different than the facial pain that she should have only on one side of her face (?) Is it more like a tension headache? Squeezing pain and not throbbing. any other symptoms like light bothering her eyes, or throbbing pain, any nausea? Please get back to me with a better description. Has she had brain imaging? What does she use for her TN? medications, gamma knife, lytic therapy, has she had a retromastoid craniotomy? I will reply after your response. Please ask questions as well. dr Frank

Customer: replied 7 months ago.
1/ She has had the facial pain now for over a year. Which comes in short spurts of severe pain.
2/ It is only on one side and she is taking anywhere between - 500mg - 2000mg of asprin/paracetamol per day.
3/ She has recently been admitted to hospital and her blood and CT scans have come out clear.
I wanted to know what dosage of pain relief you would recommend and what triggers off the pain in neuralgia??
She has had none of the therapies that you have described..
Expert:  Dr. Frank replied 7 months ago.

So the usual medications for trigeminal neuralgia are medications that treat neuropathic pain. The most popular is pregabalin (known as Lyrica here in the US), or gabapentin (Neurontin). This will reduce the intensity and also the frequency of the attacks. In TN patients, everyone has a different trigger, so it can be a brush up on her chin, or brushing her teeth, whatever, but there is a trigger. So if you can identify it and remove it, that might help. Aspirin/paracetamol is not a usual treatment for this condition. Alternatively, Carbamazepine (tegretol) can be used. There are more aggressive therapies as well, You can inject the gasserian ganglion with alcohol to stop firing of pain, or you can use a specialized pinpoint radiation treatment called gamma knife to knock out or ablate the pain pathways, that can make you pain free for up to 6 months.

Expert:  Dr. Frank replied 7 months ago.

So the pain starts from some stimulus on the face, and then the ganglion, that is deep in the face, starts to send shooting or lancinating pain sensations down into either the jaw, the cheek or the forehead area. If all the therapies I described above fail, then you can get a surgery where you make a tiny hole through the skull behind the ear, and go and move a vein in an area known as the pons of the brain, taking pressure off the nerve that brings pain sensations back up to the brain. That is called a retromastoid craniotomy. That can be a curative procedure. I hope that helps. In Australia, I expect you would have to go to a larger university medical center, but I really do not know from here. Please get back to me with questions and I will respond, or if satisfied with this answer, please remember to rate my service by clicking on the rating stars as that is how I am compensated for this work thanks dr frank

Customer: replied 7 months ago.
Hi Dr. Frank,Thanks for the advice - She has also now been admitted to hospital for another very painful head condition that they suspect is linked to the neuralgia. They think that she has a 'cluster migrain' that has come from it? The pain is now much more prolonged and also more painful at the front of the head and around the eye and nose. She is on a number of painkillers:1/ What exactly is this?
2/ What and how long are the effects?
3/ How is this linked to the ganglia?
4/ What are the causes of this?
5/ What is any are the triggers?
6/ What are the known pain relief and also cures for this 'cluster' migrain'?Thanks,
Customer: replied 7 months ago.
Is this a seperate I have to respost or are you able to answer?
Expert:  Dr. Frank replied 7 months ago.

Oculocephalic migraine or cluster headache is a variant of migraine. One part of that grouping of disease includes Reiter's Cephalgic Migraine, which is similar to V1 trigeminal neuralgia, only the pain is more constant, not in shooting episodes. It comes from inflammation of the sensory and autonomic nerves that innervate the eye and around the eye. Those nerves wrap themselves around a part of the internal carotid artery, and in vascular migraine, they can be irritated and the patient perceive periorbital pain. We have not identified specific triggers in this condition, stress is always thought to be the most common, but it can be foods like smoked meats with sodium nitrates, or aged cheeses, or for some, just noises or light at a certain frequency. The cell bodies of all cranial nerves are found in ganglia, so to treat the nerve directly, you try to modulate the nervous activity within the ganglion itself. One of the better cures for cluster headache is nasal oxygen. An oxygen tank, regulator set at up to 6 liters/min, and a nasal cannula with two prongs up the nose will help reduce the intensity of cluster headache or oculocephalic migraine. Also specific NSAID medications like indomethacin. The neuropathic medications I listed earlier will also help for both cluster and TN. Rohan, get back to me here if I can help further and I will reply. Or if satisfied with this answer, please remember to rate my service by clicking on the rating stars, as that is how I am compensated for this work Dr Frank

Expert:  Dr. Frank replied 7 months ago.

Rohan, it says you are in Australia. I am in NYC, so it is more difficult to call you. But I can call you on Skype if you need a phone call. It is an additional charge, and may not be necessary, but if you want to talk, put your number in the offer box and a time to call. It is 9 AM now in NYC. Dr Frank

Expert:  Dr. Frank replied 7 months ago.

There is some computer problem now and I cannot offer the phone option, let me know if you want that service and I can ask customer service to set it up. Otherwise, just ask more questions on this chat line if you have them and I will reply Dr Frank