Facial Swelling, Headaches, and Nausea: Neurological Symptoms

Facial issues, headaches, dizziness, and nausea?

Hello, doctor.
This week, I've started experiencing some strange symptoms.
Initially, my left cheek felt heavy and reddened, but I didn't think much of it.
This week, my left cheek has begun to swell, although the redness has disappeared.
It still feels heavy and swollen, starting from below the cheekbone and extending to the lower part of my face.
I constantly feel a sensation of heat in the swollen area, which ranges from the left temple down to the lower part of my face near my ear.
At the same time, I feel very dizzy, have a tight headache, and overall weakness, but I haven't had a fever.
I've been feeling nauseous for several days but haven't vomited and can't eat anything.
I have consulted an ENT specialist, a neurologist, and a dentist, but they couldn't find the cause.
Blood tests showed a slight inflammatory response in my white blood cells.
Since I'm feeling extremely unwell and the medication hasn't provided much relief, I'm unsure what to do next.
I would appreciate your help.
Thank you!

Miss Wang, 30~39 year old female. Ask Date: 2024/05/23

Dr. Jiang Junyi reply Neurology

Dear Miss Wang,
You mentioned that "the area of heat extends from the left temple down to the lower part of the face near the ear, feeling warm and stuffy." The area of heat you described primarily corresponds to the distribution of the mandibular branch of the trigeminal nerve.
This includes the auriculotemporal nerve and the buccal nerve.
The symptoms of trigeminal neuralgia can occur without any prior warning, and the pain may feel electric, sharp, cutting, or burning.
After subsiding, it can recur, which is different from other types of pain, as anti-inflammatory and analgesic medications are not very effective for trigeminal neuralgia.
There are many causes of trigeminal neuralgia, with approximately 80% attributed to compression of the trigeminal nerve at the brainstem entry point by vascular structures.
Other causes, such as vestibular schwannoma, meningioma, multiple sclerosis, and herpes zoster, can amplify normal sensory signals, such as touch and temperature, into pain signals.
The treatment for trigeminal neuralgia primarily involves anticonvulsant medications, with the most commonly used being carbamazepine (Tegretol), oxcarbazepine (Trileptal), and lamotrigine.
These anticonvulsants have been proven effective in treatment.
For difficult cases, I recommend the following medical advice: consider changing doctors to gain a different treatment perspective, and seek a nearby hospital with an emergency department to consolidate medical information and understand the purpose and timing of each medication.
It is advisable to consult a neurologist for examination and discussion.
Thank you for your inquiry.
If you have further questions, feel free to discuss them! Wishing you good health, peace, and joy.
Dr.
Jiang Junyi, Hua Medical/Tao Medical

Reply Date: 2024/05/23

More Info

Facial swelling, headaches, and nausea can be concerning symptoms that may indicate an underlying neurological or systemic issue. Based on your description, it seems that you are experiencing a combination of facial discomfort, headaches, and gastrointestinal symptoms, which can be interconnected in various ways.

Firstly, the swelling on the left side of your face, particularly around the cheekbone and extending towards the ear, could suggest several possibilities. One common cause of unilateral facial swelling is sinusitis, particularly if there is any associated pressure or pain in the sinus areas. This could lead to headaches and a feeling of fullness in the face. However, since you mentioned that redness has subsided, it may not be an acute inflammatory process.

Another possibility is that the swelling could be related to a dental issue, such as an abscessed tooth or gum infection, which can cause referred pain and swelling in the facial region. Given that you have consulted with dental professionals, it would be prudent to ensure that there are no underlying dental problems that might have been overlooked.

The sensation of heat and tightness in your head, along with the headaches, could be indicative of tension-type headaches or even migraines, especially if they are accompanied by nausea. Tension headaches can often be exacerbated by stress, poor posture, or muscle tension in the neck and shoulders. It might be beneficial to evaluate your stress levels and consider relaxation techniques or physical therapy to alleviate muscle tension.

The nausea and lack of appetite you are experiencing could be a response to the discomfort and pain you are feeling. When the body is under stress or experiencing pain, it is not uncommon for the gastrointestinal system to react, leading to symptoms like nausea and decreased appetite. It is essential to stay hydrated and try to consume small, bland meals to help manage these symptoms.

The fact that your blood tests indicated a slight inflammatory response is noteworthy. This could suggest that there is an ongoing process in your body that requires further investigation. Conditions such as infections, autoimmune disorders, or even allergic reactions could lead to similar symptoms. It might be worthwhile to follow up with a rheumatologist or an allergist if your symptoms persist or worsen, as they can provide a broader perspective on potential systemic issues.

Given the complexity of your symptoms and the lack of a clear diagnosis from the specialists you have seen, it may be beneficial to seek a second opinion or consult a neurologist who can perform a comprehensive evaluation. They may recommend imaging studies, such as an MRI or CT scan, to rule out any structural abnormalities or neurological conditions that could be contributing to your symptoms.

In summary, while your symptoms may be interconnected, they could stem from various causes ranging from sinus issues to dental problems or even neurological conditions. It is crucial to continue seeking medical advice and to advocate for yourself in pursuing a thorough evaluation. Keeping a detailed symptom diary, including when symptoms occur and any potential triggers, can also be helpful for your healthcare providers in diagnosing your condition. Remember to take care of your overall well-being, and do not hesitate to reach out for support from healthcare professionals as you navigate this challenging situation.

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