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Severe pain around cheekbone and eye area. CT, MRI, scan and eye test done. Amitryptilene taken. Advise

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53yrs, 8stone, 5ft1in. I have had almost constant, severe aching pain on right side of face around cheekbone & eye area since May. In morning it is not so severe & normal colour, as day goes on pain gradually worsens & area goes dark brown as if bruised. Pain worsens if I go out in cold, damp or windy weather, much worse now winter is setting in.Had hysterectomy in April, don't know if this bears any significance, could this have been caused by operation or anaesthetic ? My doctor has prescribed Amitryptilene 10mg at night at present, reduced from 25mg as I have 2 children to care for and they were making me drowsy and absent-minded. I am also taking 2x500mg Paracetamol two to three times a day to help relieve pain. Had CT scan ruling out dental & sinus problems, had eye test ruling out glaucoma. Had MRI scan which shows nothing.Still in alot of pain most of the time, can you help please?
Posted Thu, 12 Apr 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 10 hours later

Thank you for your query.

1. The description and onset of your symptoms appears to be consistent with Right Trigeminal Neuralgia.

2. Hysterectomy is not directly related to this. However, since hysterectomy is a major procedure, stress may have caused activation of latent herpes (reactivated chickenpox virus or shingles)of the nerve around the time of the operation. This needs to be ruled out by your treating physician

3. Discoloration is rare and may be related to Trigeminal Trophic Syndrome especially if you have decreased sensation around your eye and cheek. It might simply be due to exposure to cold. There are many rare conditions which must be ruled out direct examination by a dermatologist. A barrier / moisturizing cream may help.

4. Besides Amitriptyline, other medication that you should get a trial with are Carbamazepine and Gabapentin. Discuss with your treating doctor regarding these medication. You can get these drugs prescribed by them.

5. It is good to hear that your CT and MRI scans are normal, ruling out common causes such dental disease and procedures, sinusitis and glaucoma. Have you had an ophthalmologist's reference?

6. You are currently on two antibiotics. Is there any particular infection being treated? I recommend that you avoid Naproxen. Naproxen may have caused a minor stroke leading to this condition.

7. The cause of Trigeminal Neuralgia is frequently unknown. A vascular loop compression would have shown up on the MRI. It sometimes has an unrelenting course.

8. Gamma Knife Radio-surgery and micro-vascular decompression are commonly used treatments in unrelenting cases.

Kindly get your MRI images reviewed for the presence of a vascular loop. You may also share the images here along with close up photographs of your right cheek with and without the discoloration / bruising.

Hope this answers your query. Should you have any additional concerns, I will be available to address them.

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