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Having Isolated Pain On Face, Getting Headache. Prescribed Medicine For Shingles. Hairline Fracture In Skull?

Posted on Tue, 26 Mar 2013

Question: 5 days ago I started having isolated pain on the left side of my face, stretching from my jaw to my cheek bone, around (but not in) my eye and up to my temple. My skin was very sensitive and I was getting gradually intensifying headaches. The doctor thought I might have an early onset of shingles and prescribed me Acyclovir and Prednisone. A rash has not occurred yet and the headaches are now more around the crown of my skull, leaving me to wonder if shingles was the correct diagnosis. About 3 weeks ago, I was hit once in the head around that area, but did not have any concussed type issues. Is it possible that I have a hairline fracture in my skull that is only now starting to hurt or give me issues? I didn't think I would have that kind of neural feeling pain in my face if that was the case. Do you have any additional thoughts? If it is some kind of fracture, can I wait a day or two to get it checked out? Any thoughts or advice on how to steer the doctors here would be appreciated. Thanks

Answered by Dr. Gopal Krishna Dash (1 hour later)

Hello,

Thanks for writing to us

I understand your concern and I have noted all your complaints

The possibilities could be 1. Trigeminal neuralgia 2. Atypical facial pain

Based upon the data that you have provided, I do not feel that you have shingles

It could be possible that traumatic damage of nerve can present in the same manner

I urge you to get examined by a neurologist. The clinical interview will clarify the nature of pain. The clinical examination will determine if there is actual trigeminal nerve involvement or not. A brain scan which also includes a bone window will resolve many issues. You may wait for few days if there are no other problems. I also suggest you to undergo a dental check up. If the scan is normal a course of gabapentine, pregabaline or carbamazepine will help reduce your pain.

So please get evaluated as I have discussed

I hope that i have addressed your problems
In case of further questions, please get back to me

Best wishes

Above answer was peer-reviewed by : Dr. Aparna Kohli

Follow up: Dr. Gopal Krishna Dash (1 hour later)

Thank you. Just to clarify, a skull fracture or other injury from the blow I took to my head a few weeks ago is unlikely to be the cause? - other than perhaps nerve damage causing the same painful sensations that trigeminal neuralgia or atypical facial pain would cause. I will ask to be treated by a neurologist and request a brain scan to rule out other possibilities. If I have trigeminal neuralgia, will I battle it the rest of my life? I read there is no cure. Can it come and go away for a few years, or will it be a constant lingering issue from here on out? Thanks

Answered by Dr. Gopal Krishna Dash (34 minutes later)

Hi,

Thanks for the feedback.

Classical trigeminal neuralgia happens in old age.

Note that traumatic nerve damage can also present in the same way.

The possibility of atypical facial pain is high in your case.

If it is primary trigeminal neuralgia and MRI shows some signs, other options do exist. You definitely need not struggle throughout your life as the management options are wide. Our first and important objective is to establish the diagnosis rather than being worried and speculating things which are not appropriate. Please do not worry much. I assure you that you will improve with time.

Please XXXXXXX a neurologist and get back to me if needed

Best wishes

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Gopal Krishna Dash (41 hours later)

Hi,

I saw a doctor and they ruled out shingles and performed a sinus x-ray, but found nothing wrong. The pain has shifted to a dull and compressing type sensation isolated around my left temple. I can feel it around my jaw and the left eyelid. They set me up for a CT Scan tomorrow and will evaluate the results before referring me to a neurologist. My question to you as a neurologist, given my symptoms: which kind of test is the most useful for you to evaluate? CT Scan or a MRI? Thank you

Answered by Dr. Gopal Krishna Dash (3 hours later)

Hello,

Thanks for the query,

If I were to be your treating doctor, I would pick MRI scan. This will pick up subtle problems in the brain also. Given the possibilities, I think you should go for MRI.

I will be glad to address if you have more queries.
If all your queries are answered, please close this discussion.

Best wishes

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Gopal Krishna Dash (3 days later)

Hi, I just received the results of my test. I obtained a copy for myself. The radiologist said that the CT of the brain is unremarkable and the cavernous sinus region and brainstem are grossly unremarkable. I have a very mild sinus disease. The Sphenoid sinuses demonstrate some mild mucosal thickening possibly representing a small 8mm mucus retention cyst or polyp. He did find Chiari One malformation within the right cerebellar tonsil extending to a much greater extent below the foramen magnum (6 to 7 mm below the foramen magnum). There is a moderate amount of crowding of CSF at the foramen magnum. Greater posteriorly. The anterior CSF is only mildly effaced.

I'll be getting a recommendation from my doctor this week, but I wanted to see if you could offer a second opinion? Is Chiari One malformation something I should treat right away or should I wait to see if the pain subsides first? Do you think that could be causing the pain and is the degree of malformation low, medium or great? Many thanks for your feedback.

Answered by Dr. Gopal Krishna Dash (3 hours later)

Hello,

Thanks for the feedback.

The decision of treatment regarding the treatment of Chiari Malformation depends upon the associated clinical findings which will be determined by a neurophysician or neurosurgeon after a detailed clinical evaluation. If you do not have headache, vomiting, stiffness of legs, urinary problem you can wait until you get an appointment with your doctor. Further, your doctor will guide you based upon the findings as I discussed. I think that you should have MRI scan for better definition of these lesions before deciding on any treatment.

Your pain could be related to both the malformation and sinus problem.

Above answer was peer-reviewed by : Dr. Shanthi.E