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Cause of chronic aural pain - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Ear, Nose and Throat Problems
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1773 Questions
User :   Hello, I am a 22 year old female. I have been experiencing severe bilateral ear pain that will radiate into my face, head, neck, teeht and jaw. I have been to doctors for over a year... They have ruled out: TMJ disorder, Eustachian tube dysfunction (they even put tubes in), The ENT's say my "ears" are fine. 2 out of 4 neuroligsts I have seen don't think that its neuroligically related, but 2 of them thought it could possibly be a type of neuralgia. I was started on Neurontin but did not find any releif and the last Neurologist I saw said it could be "facial migraines." I am in the process of weening off of an SSRI so I can begin preventative migraine medication.
In addition to this pain, I have been battling with an increasing amount of fatigue especially in late morning/afternoon that is becoming very bothersome despite trying to get a good exercise routine going and eating better. I also have noticed that "Cold Air" such as AC in a room will make the pain worse in my face. I am currently in Florida and I always have to bring a sweatshirt with me for indoors because I can't handle the cold air.
I would appreciate your help. I am tired of taking narcotic pain releivers. . .
Doctor :   Hi
Doctor :   I am Dr. xxxxr
Doctor :   let me read the query
Doctor :   Give me a couple of minutes
User :   Alrighty
Doctor :   Ok
Doctor :   How frequent are the pain attacks?
User :   in the last few weeks it has been dailly
Doctor :   What is the severity on a scale of 1 to 10?
User :   it will vary... it has brought me to the ER almost 3 times
User :   the last few weeks probably about a 6?
User :   the pain is intense.. but dull/achey type..
Doctor :   Generally, where does the pain start after a complete remission?
User :   i usually feel it deep in my ears first
User :   then face/jaw/teeth
User :   and head
Doctor :   Since the major medical causes are ruled out now
Doctor :   the uncertain ones remained
Doctor :   such as Migraine, Neuralgia, Fibromyalgia
Doctor :   Now the trial and error method should start by the treating doctor
Doctor :   Migrain is the commonest of all
User :   yeah.. the trial/error has been going on for a long time :/
Doctor :   Hence putting on prophylaxis for migraine is the way
Doctor :   Why were the SSRI's given?
User :   do you believe the fatigue is associated with the migraine?
Doctor :   Did you seek the help of your treating doctor about changing it ?
User :   i had an issue with an axiety disorder for a few years.. but the ear pain started once I was much better
Doctor :   Migraine can be associated with fatigue
Doctor :   When were the SSRi's revised?
Doctor :   I mean the dose and frequency?
User :   I just revised them less than a week ago. I went from 100mg daily to 50mg daily
User :   on Zoloft
Doctor :   ok
Doctor :   Any change in the nature of the pain after this revisal
Doctor :   as you said the pain is more frequent and seveere
Doctor :   since one week
User :   ive been getting more "fatigued/lightheaded" since ive revised
User :   the last couple weeks
User :   the pain has been more severe
Doctor :   Ok can you go back to the same dose with the help of your treating doctor and see if this has caused you more problems
Doctor :   The second is taking the migraine prophylaxis
User :   but i can't take the SSRI with the migraine medication
Doctor :   There is an optimal dose that can be given
Doctor :   Since the migraine medication is started with low dose and gradually increased
Doctor :   I was just wondering if we can acheive a combination where you get pain relief
User :   does the SSRI help with pain also?
Doctor :   yes
Doctor :   They do
User :   My last dr told me i couldn't mix them :/
Doctor :   Ofcourse your treating doctor should be the best person to notice these changes
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