Trigeminal Neuralgia or Migraine: Your Facial Pain

Q: Trigeminal Neuralgia or Migraine: Your Facial Pain

Hello： The branches of the trigeminal nerve are distributed from top to bottom in the forehead, cheeks, and chin. <br>Trigeminal neuralgia often occurs in the areas innervated by its lower two branches, with a lower incidence in the region of the first branch. <br>Additionally, t

Trigeminal neuralgia or migraine?

Hello doctor, I started having a cold at the end of June, which developed into sinusitis, but by the end of July, I had mostly recovered.
However, I have been experiencing several issues since then.
Every morning, I feel a sense of fullness in my right ear, and my hearing doesn't seem as good as before.
There is also a feeling of swelling in my right nostril, and I have a dull pain in my lower right jaw.
I visited a dentist, who diagnosed me with temporomandibular joint (TMJ) inflammation and recommended a bite splint, but the appointment is scheduled for a later date, so I haven't had it done yet.
I also saw an ear specialist, who found no issues during the examination and checked my nasal cavity, ruling out nasopharyngeal cancer.
The doctor suggested it might be a dysfunction, so I accepted that diagnosis.
At the beginning of August, I went swimming, and my right facial pain became severe, leading to a headache.
Over-the-counter pain relievers did not help, so I went to the emergency room, where they conducted blood tests and a head X-ray, finding no issues.
They suggested it could be related to the TMJ and recommended I see a neurologist or dentist.
A few days later, I consulted a neurologist, who diagnosed me with typical migraines and prescribed medication to improve cerebral circulation, advising me to keep a record of my symptoms.
However, the pain in my right face persists, and my vision in the right eye feels strange.
Occasionally, I also experience neck pain.
I am concerned whether there might be something in my brain or an issue with the trigeminal nerve, or if I have consulted the wrong specialist.

Huang Xiao-jia, 20~29 year old female. Ask Date: 2017/08/08

Dr. Jiang Junyi reply Neurology

Hello: The branches of the trigeminal nerve are distributed from top to bottom in the forehead, cheeks, and chin.
Trigeminal neuralgia often occurs in the areas innervated by its lower two branches, with a lower incidence in the region of the first branch.
Additionally, trigeminal neuralgia rarely affects vision.
A unique phenomenon of trigeminal neuralgia is that it can be triggered under certain circumstances, such as touching the skin on the face, eating, yawning, brushing teeth, or exposure to cold air.
This pain is extremely distressing, and some patients may avoid washing their face or eating during an episode.
Clinically, I would recommend that patients continue their follow-up treatment at the same hospital.
If the response to migraine medications is poor, the physician can persuade the health insurance authority to approve further examinations and treatments.
I suggest you consult a neurologist to discuss evaluation and treatment.
Wishing you good health, peace, and joy.
Dr.
Tao, Neurology, cares about you.

Reply Date: 2017/08/08

More Info

Hello,
Thank you for sharing your concerns regarding your facial pain and the various symptoms you've been experiencing. Based on the information you've provided, it seems that you are dealing with a complex situation that may involve multiple factors, including sinus issues, potential temporomandibular joint (TMJ) dysfunction, and possibly migraine or trigeminal neuralgia.

Understanding Your Symptoms
1. Sinus Issues: You mentioned having a cold and subsequently developing sinusitis. Sinus infections can lead to facial pain, pressure, and a feeling of fullness in the ears and nasal passages. This could explain some of the discomfort you're feeling in your right ear and nasal area.

2. Temporomandibular Joint (TMJ) Dysfunction: The dull pain in your lower jaw and the recommendation from your dentist to use a bite splint suggest that you may be experiencing TMJ dysfunction. This condition can cause pain in the jaw, face, and even lead to headaches. It can also be exacerbated by stress or teeth grinding, which is common during periods of discomfort.

3. Migraine: The neurologist's diagnosis of typical migraine could also be relevant. Migraines can present with unilateral facial pain, and they may be accompanied by other symptoms such as visual disturbances, neck pain, and sensitivity to light or sound. The fact that your pain worsens with certain activities, like swimming, could indicate a migraine trigger.

4. Trigeminal Neuralgia: This condition is characterized by sudden, severe facial pain that can be triggered by light touch or certain movements. While your symptoms do not seem to fit the classic presentation of trigeminal neuralgia, it is still a possibility that should be considered, especially if the pain is sharp or electric-like.

Next Steps
Given the complexity of your symptoms, here are some recommendations:
1. Follow-Up with Specialists: Since you have already seen an ENT and a neurologist, it may be beneficial to follow up with a dentist who specializes in TMJ disorders. They can provide further evaluation and treatment options, such as physical therapy or a custom bite splint.

2. Keep a Symptom Diary: Documenting your symptoms, including when they occur, their intensity, and any potential triggers, can be helpful for your healthcare providers. This information can assist them in making a more accurate diagnosis.

3. Consider Imaging Studies: If your symptoms persist or worsen, discussing the possibility of advanced imaging studies, such as an MRI, with your neurologist may be warranted. This can help rule out any structural issues in the brain or surrounding areas.

4. Pain Management: If your pain is not adequately controlled with over-the-counter medications, discussing prescription options with your healthcare provider may be necessary. Medications specifically for migraines or nerve pain could be beneficial.

5. Stress Management: Since stress can exacerbate both migraines and TMJ dysfunction, exploring stress management techniques such as mindfulness, yoga, or counseling may provide additional relief.

Conclusion
Your symptoms are multifaceted and could be attributed to a combination of sinus issues, TMJ dysfunction, and migraines. It is crucial to continue working with your healthcare providers to explore these possibilities and find an effective treatment plan. Remember, it is important to advocate for your health and seek further evaluations if you feel your concerns are not being addressed adequately.

Wishing you the best in your journey towards relief and recovery.

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