Trigeminal, but not Trigeminal Neuralgia. What is it? HELP

Posted by fdouglass @fdouglass, Jul 5, 2023

I came down with a virus mid December that would not go away. 5 rounds of antibiotics later and a CT-scan, I got into a ENT. He told me that my sinuses looked great and I had no sinus problems, but that it was my trigeminal nerve. I had sinus pressure behind the eyes, pain, mucus, and I felt like my eyeballs were being pushed out of my head. ENT referred me back to my PCP and said for her to put me on Carbamazepine. The carbamazepine worked on 50% of my issue. Then a MRI and an appointment with my neurologist. She said it was just migraines and nothing to do with my trigeminal. She put me on nortriptyline and said to start weening off the carbamazepine after 30 days. While I was on both, all was great. I felt like I had my life back. A week after I hade weened off of the carbamazepine all the sinus symptoms came back. So I called and she put me back on the carbamazepine. It has been a month since I have been back taking both. I started to feel better and then, AGAIN, I am having sinus pressure behind my eyes, pain, mucus, and bad headaches day and night. Every time it feels like the flu, but the flu goes away.

Has anyone been diagnosed with anything like this and told it is an overactive trigeminal nerve?

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@fdouglass

See a Neurologist who specializes in headache syndromes.

They are multifactorial and can have many things involved.

You ever get checked for allergies before you caught a virus? Could have exacerbated underlying inflammation from allergies.

The carbamazepine was most likely calming your nerves (nervous system hypersensitivity) which was likely also addressing some type of anxiety.

If the virus left some residual inflammation in the tissue irritating the nerves this can also happen. You don’t need any type of infection to have low level inflammation of the nerves.

Did anyone try you on an oral steroid for inflammation?

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@smithakar

@californiazebra @fdouglass Your case reminds me of mine. I posted under a few discussion groups (ENT, Covid, Neuropathy) to see if anyone can relate. I have the same issues where my nose and teeth have constant pain. Sinus pressure/pain with clear scans. That is interesting how carbamazapine works for you to bring the pain level down if that's the case I would recommend going back to Neuro. Carbamazepine did nothing for me. I tried a trigieminal nerve block as well. The only thing that helped was 6 weeks post sinus surgery I felt better but the pain came back so the doctors are thinking its not sinus related. I can understand your pain. I wish something worked to relieve my symptoms so I can have my life back.

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For me the Carbamazepine works like an allergy medication. Without it the clear mucus, pressure and pain are unbearable. But, it seams I may have to raise it again because symptom are coming back. Currently I am on 200mg x2 daily.

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@nrd1

@fdouglass

See a Neurologist who specializes in headache syndromes.

They are multifactorial and can have many things involved.

You ever get checked for allergies before you caught a virus? Could have exacerbated underlying inflammation from allergies.

The carbamazepine was most likely calming your nerves (nervous system hypersensitivity) which was likely also addressing some type of anxiety.

If the virus left some residual inflammation in the tissue irritating the nerves this can also happen. You don’t need any type of infection to have low level inflammation of the nerves.

Did anyone try you on an oral steroid for inflammation?

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No tests for allergies before virus. I was put on a Flonase steroid. It does not seem to help. Thanks for the info. I will look into that.

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@californiazebra

Wow @johnspirit2 that all sounds awful for you. Thank you for sharing your story. I hope by some miracle you've seen your last attack.

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I completely understand. I had a great PCP that was genuinely trying to help. Then she took another position as an er doctor. All the other doctors either pass the buck and send me to another specialist saying it is not something they treat or say "oh, it is just migraines". It for sure causes migraines rains. But, it is not just migraines. How do you find a doctor that deals with crazy sinus issues not caused by your sinuses. I hope you find your answers soon.
Thanks @johnspirit2

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I have two headache disorders, chronic migraine and hemicrania continua, and trigeminal nerve pain is very common for me and others with HC. I am not saying you have either of these, but if you have access to a headache specialist I would encourage you to go see one; or at least see a different neurologist. Feeling like I have the worst sinus infection ever in my face, severe ear pain and feeling fullness in both, pain behind my eye and feeling like someone is squeezing the back of my eyeball, severe upper molar pain are the most frequent for me. However, mucus is not a factor. When I have mucus it is due to allergies or diet sensitivities. I am getting some relief from Vyepti infusions every 12 weeks which is a CGRP migraine medication.
Keep advocating for your health care and good luck.

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@caosborn

I have two headache disorders, chronic migraine and hemicrania continua, and trigeminal nerve pain is very common for me and others with HC. I am not saying you have either of these, but if you have access to a headache specialist I would encourage you to go see one; or at least see a different neurologist. Feeling like I have the worst sinus infection ever in my face, severe ear pain and feeling fullness in both, pain behind my eye and feeling like someone is squeezing the back of my eyeball, severe upper molar pain are the most frequent for me. However, mucus is not a factor. When I have mucus it is due to allergies or diet sensitivities. I am getting some relief from Vyepti infusions every 12 weeks which is a CGRP migraine medication.
Keep advocating for your health care and good luck.

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@caosborn-

Hi. Could you please explain how you first experienced hemicrania continua and or how your headache pain began with all 3.

I actually had sinus surgery, not accurately diagnosed in my opinion and now I have what feels like all of those headache pain syndromes that I did not have before surgery. It’s been very hard to navigate through and believe what any ENT says. Sinus or not sinus issues.

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@caosborn

I have two headache disorders, chronic migraine and hemicrania continua, and trigeminal nerve pain is very common for me and others with HC. I am not saying you have either of these, but if you have access to a headache specialist I would encourage you to go see one; or at least see a different neurologist. Feeling like I have the worst sinus infection ever in my face, severe ear pain and feeling fullness in both, pain behind my eye and feeling like someone is squeezing the back of my eyeball, severe upper molar pain are the most frequent for me. However, mucus is not a factor. When I have mucus it is due to allergies or diet sensitivities. I am getting some relief from Vyepti infusions every 12 weeks which is a CGRP migraine medication.
Keep advocating for your health care and good luck.

Jump to this post

@caosborn, when you say "feeling fullness in both" are you referring to your sinuses and ears feeling full? But they are not? if so, when I finally got in to see my ENT, I was so excited because I thought I knew what was wrong with me (impacted sinuses), and he would come into the room and say, wow your sinuses are impacted. We have to do something about that. BUT, he actually said the opposite. He said he thought I had had sinus surgery because they looked so good. Then he told me that 90% of the people that come to him with sinus issues actually have trigeminal issues. He also said your trigeminal controls everything to do with the sinuses. Mucus, pressure, pain, etc, and that your trigeminal could give you the sensation of pressure and pain in your sinuses when in fact they are clear. I have not been able to have anyone else confirm this since. But, seems to be what both of us are dealing with, if I understand you correctly?

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@nrd1

@caosborn-

Hi. Could you please explain how you first experienced hemicrania continua and or how your headache pain began with all 3.

I actually had sinus surgery, not accurately diagnosed in my opinion and now I have what feels like all of those headache pain syndromes that I did not have before surgery. It’s been very hard to navigate through and believe what any ENT says. Sinus or not sinus issues.

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Early in 2014 I had what I thought was a migraine on one side of my head for 3 months straight....every day, unremitting. My PCP referred me to a neurology clinic and they gave me an appointment with a certified headache specialist. She immediately suspected hemicrania continua and prescribed the medication which is used as a diagnostic confirmation. I had trigeminal nerve pain in my face from the beginning. Over the years the nerve pain has become more severe and more of the trigeminal nerve areas involved to the point it sometimes overshadows the headache pain. Based on symptoms described at subsequent visits she added chronic migraine to my diagnoses. My migraines feel much the same as HC but without the nerve pain.
Interestingly, although I had never given it much thought until now, there were times I would make an appointment with my PCP because I thought I had a sinus and/or middle ear infection and assumed my headaches where sinus related. All clear was the examination result each time. Of course that was before the headaches became continuous.

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@fdouglass

@caosborn, when you say "feeling fullness in both" are you referring to your sinuses and ears feeling full? But they are not? if so, when I finally got in to see my ENT, I was so excited because I thought I knew what was wrong with me (impacted sinuses), and he would come into the room and say, wow your sinuses are impacted. We have to do something about that. BUT, he actually said the opposite. He said he thought I had had sinus surgery because they looked so good. Then he told me that 90% of the people that come to him with sinus issues actually have trigeminal issues. He also said your trigeminal controls everything to do with the sinuses. Mucus, pressure, pain, etc, and that your trigeminal could give you the sensation of pressure and pain in your sinuses when in fact they are clear. I have not been able to have anyone else confirm this since. But, seems to be what both of us are dealing with, if I understand you correctly?

Jump to this post

Yes, I am. There were times I would make an appointment with my PCP because I thought I had a sinus and/or middle ear infection and assumed my headaches where sinus related. All clear was the examination result each time. Later I learned from my headache specialist that the trigeminal nerve was responsible for what I was feeling. Things made more sense for me then.

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Yes!

I have had bilateral pain in my face & molar teeth for nearly 8 years!
I have been to multiple dentists & even neurologist scratching his head not able to understand why I have this chronic facial pain felt behind my nose/ top teeth & constant pressure behind my cheeks!
I do believe that I also have irritated my trigeminal nerve.

I’m so frustrated why nobody can find this problem & treat it!

I’m at the stage that when I go to bed I really couldn’t care if I don’t wake up 🤷‍♀️.

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