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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Tingling Sensations, Headaches, Facial Pain And Dizziness?

I am 25 years old experiencing tingling sensations, headaches, facial pain, and dizziness. This is mostly felt on the left side of my body. In addition, I have been experiencing blurry vision in the left eye. Because of my geographical location and family history, I feared Multiple Sclerosis. I had an MRI done without contrast. Here is the result: There is a single small hyperintense FLAIR focus in the right superior frontal lobe subcortical white matter is non-specific. No areas of restricted diffusion to indicate acute infarct. No susceptibility foci on the GRE sequence to indicate prior intracranial hemorrhage or hemosiderin. Because of my age, white matter findings do concern me. However, there was just one one small white matter found, and it was non-specific which usually doesn t indicate MS. Because of my symptoms, do you think I should get an MRI with contrast?
Sat, 26 Nov 2022
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Anesthesiologist,  's  Response
Hello,

The MRI findings do not indicate anything in particular. Hence, you do not need to worry about MS. The following are possible conditions that fit your symptoms:
1) Trigeminal neuralgia (TN)
2) Cluster headache
3) Migraine headache

Mostly yours is trigeminal neuralgia. Trigeminal neuralgia (TN), also known as tic douloureux, is a distinctive facial pain syndrome that may become recurrent and chronic. It is characterized by unilateral pain following the sensory distribution of cranial nerve V (typically radiating to the maxillary or mandibular area in 35% of affected patients). This is often accompanied by brief facial spasms or tics.

The treatment options are as follows:
1) Pharmacologic therapy: Carbamazepine is the best studied drug for TN. It is given as Carbamazepine immediate release tablet 200mg twice daily taken orally. Dose may be increased based on the need.
2) Over the years, patients may require a second or third drug to control breakthrough episodes and finally may need surgical intervention
3) Lamotrigine and baclofen are second-line therapies
4) Gabapentin can also be used in resistant cases
5) Other treatments include:
a) Percutaneous procedures (eg, percutaneous retrogasserian glycerol rhizotomy)
b) Surgery (eg, microvascular decompression)
c) Radiation therapy (i.e., gamma knife surgery)

Only if medications fail to produce a response, the other strategies are used. Please do consult a neuro-physician and discuss the above treatment options.

Take care. Hope I have answered your question. Let me know if I can assist you further.

Regards,
Dr. Pallavi M., Anesthesiologist
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What Causes Tingling Sensations, Headaches, Facial Pain And Dizziness?

Hello, The MRI findings do not indicate anything in particular. Hence, you do not need to worry about MS. The following are possible conditions that fit your symptoms: 1) Trigeminal neuralgia (TN) 2) Cluster headache 3) Migraine headache Mostly yours is trigeminal neuralgia. Trigeminal neuralgia (TN), also known as tic douloureux, is a distinctive facial pain syndrome that may become recurrent and chronic. It is characterized by unilateral pain following the sensory distribution of cranial nerve V (typically radiating to the maxillary or mandibular area in 35% of affected patients). This is often accompanied by brief facial spasms or tics. The treatment options are as follows: 1) Pharmacologic therapy: Carbamazepine is the best studied drug for TN. It is given as Carbamazepine immediate release tablet 200mg twice daily taken orally. Dose may be increased based on the need. 2) Over the years, patients may require a second or third drug to control breakthrough episodes and finally may need surgical intervention 3) Lamotrigine and baclofen are second-line therapies 4) Gabapentin can also be used in resistant cases 5) Other treatments include: a) Percutaneous procedures (eg, percutaneous retrogasserian glycerol rhizotomy) b) Surgery (eg, microvascular decompression) c) Radiation therapy (i.e., gamma knife surgery) Only if medications fail to produce a response, the other strategies are used. Please do consult a neuro-physician and discuss the above treatment options. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Pallavi M., Anesthesiologist