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Sharp Pain In Ear. Feeling Sleepy Due To Medication. What Is The Cause And Required Treatment?

Posted on Mon, 18 Mar 2013

Question: I have a recurring severe severe shocking pain that starts slowly building up around and feels like it is in my left ear. Doctors are giving me pain relief which just makes me sleepy and pain does not go away? I am told that my ear is perfect and pain is probably coming from nerves behind and around ear? What causes this pain to suddenly begin and how best to cope with it. It is completely debilitating and recently spent time almost hysterical in a hospital emergency where they administered morphine for the pain! It was only about 4-5 times a year, but have had it 3 times in last 4 weeks! I have taken Lyrica and pain still there but feel very dopey. Have used Endone in the past and same result but still have the pain.
I have had two MRI's which show nothing obvious to my neurologist or ear specialist.
Pain sometimes starts shooting up my head on left side and it is unbearable...can't even touch my hair at that point
XXXXXXX

Answered by Dr. Sudhir Kumar (16 minutes later)

Hi XXXXXXX

Thank you for posting your query.

I can understand the discomfort you face on account of the pain. This is more so, as no definite diagnosis has been made, and you have been using medicines empirically.

Normal MRI excludes several diseases, such as tumors of the hearing nerve, infections, blood clots, etc.

If your pain is transient, lasting for a few seconds to a minute, then we are dealing with neuralgia (nerve pain). The commonest nerves implicated are trigeminal nerve and glossopharyngeal nerve (these nerves start from the brain, and come to face, around the ear, throat, etc).

Initial treatment consists of medications such as carbamazepine or oxcarbazepine.

In some cases, radiofrequency ablation (radiation) or microvascular decompression (minor surgery) may be required.

I hope it helps. Please get back if you have more queries.

Wishing you good health,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (5 minutes later)

No this doesn't really help me. The pain lasts up to 48 hrs, climaxes in a shocking way for a second or two then starts to go away. It is quite terrifying and worries me that it has become more frequent suddenly.

I have it now and the Lyrica is just dulling the pain but I cannot touch near ear or head above my ear. My neurologist is overseas at present so cannot call him, but he seems to be at a loss other than to prescribe these pain killers that don't have much effect.
XXXXXXX

Answered by Dr. Sudhir Kumar (16 minutes later)

Thank you for getting back and providing more information.

Sorry for the incomplete reply above due to lack of adequate clinical data.

Based on your description, the most likely cause is migraine. In migraine, the pain lasts more than 4 hours and less than 72 hours, along with a feeling of nausea or vomiting. Pain may get worse on exposure to bright lights or noise.

Preventive therapy is required if you have more than two episodes of pain in a month. Good medications for this purpose are beta blockers, divalproex and topiramate.

For pain relief, you may take sumatriptan or rizatriptan tablets.

I hope it helps. I again apologize for the unhelpful reply above.

Best wishes,
Dr Sudhir Kuamr MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (3 minutes later)

Thank you for trying. It is definitely not a migraine ...no nausea, vomiting, problems with bright lights etc. It is very localised in and around my left ear only. I feel fine everywhere else just unable to move my head much, smile or grimace etc.

It becomes more intense and sends pain shooting up into my head on left side and scalp is tender - cannot brush hair or touch my hear or head.

Answered by Dr. Sudhir Kumar (14 minutes later)

Thank you for getting back.

Though Iagree with you that you do not have the features of classical migraine, the most likely diagnosis in your case is an atypical migraine.

Ear pain (otalgia) can be the predominant manifestation of migraine. Please read the reference below:

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Similarly, nausea, vomiting, photophobia, etc may be absent in about one-third of cases with migraine.

Scalp tenderness and hyperaesthesia (allodynia: increased sensitivity to touch, combing, brush, etc) is a typical feature of certain migraines. Please read the reference below:

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Best wishes,
Dr Sudhir Kumar MD DM

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar