What should I take for the constant ache in my face?
QSINCE a lengthy session in the dentist’s chair some months ago, I have hadnerve pain in my left cheek. The dentist has X-rayed my teeth but found no problems. My doctor told me to take painkillers, but I don’t like taking ibuprofen for longer than a week. My symptoms seem to match trigeminal neuralgia.
AJoyce Findlay, Sunbury-on-Thames, Surrey. Whole books as thick as your arm have been written on the diagnosis of facial pain as there are so many potential causes, and misdiagnosis is common. Most often it is mistaken for dental pain — even to the extent of people having teeth taken out in an effort to resolve it.
A neuralgia is a severe or sharp pain originating in a nerve that is irritated or damaged in some way. head and facial pain may involve any one of nine nerves — including the trigeminal, which carries sensations from the face (the teeth, eyelids and lining of the mouth) back to the brain; the nervus intermedius; the glossopharyngeal; the vagus; and the upper cervical spinal nerve roots in the neck.
The anatomy of the head and neck is complex, as is the route taken by the nerves that serve this area. The trigeminal, for example, has two branches, one on either side of the face, which each fork into three sections that can sense pain in the forehead, the mid-face and the jaw. As well as carrying sensory information about pain, these nerves carry impulses to the muscles used for eating, which increases the difficulty of accurate diagnosis.
A neuralgia can cause sudden and intense bursts of pain. Sometimes they have trigger zones that, when stimulated, can provoke an attack. Those affected may find that even splashing their face with cold water can trigger the pain, which can be a sharp and intense feeling, or a continuous ache, burning or throbbing.
About 90 per cent of cases of this type are caused by compression of the trigeminal nerve by an abnormal loop of a blood vessel, just inside the point where it enters the brain. So it seems unlikely that your pain is linked to the long dental session you mention.
Furthermore, although trigeminal neuralgia is one of the most common causes of facial pain, it is rare, affecting about 19,000 people in the UK. It is more common in women than men, and high blood pressure may be a risk factor, as is migraine, though why is not clear.
If trigeminal neuralgia is the problem, carbamazepine is proven to be effective; 200mg to 2,400mg per day may be needed. The potential side-effects are drowsiness and nausea, but these are minimised by increasing the dose slowly until benefit is achieved.
For patients who do not respond to this treatment there are a variety of surgical options, such as microvascular decompression, but this is a major operation in which the skull is opened and blood vessels are removed or separated from the trigeminal nerve. Few of these have been studied in controlled trials.
The question is whether trigeminal neuralgia is the correct diagnosis for you. Neither your GP nor your dentist seems certain.
My advice is that you consult your GP further and ask that you are referred for the expert opinion of a consultant neurologist.
QSEVEN years ago, I was told I had type 2 diabetes. I lost a few pounds and my results changed, so I didn’t needmedication. Since then I have gone to the diabetic screening service annually. Last year, I was told I had slight retinopathy in one eye and should keep a close watch on my diabetes and bloodpressure. Can I help myself with any added vitamins or plenty of greens, or is it just old age?
AP. Windmill, Burnt Oak, London. DIAbeTIc retinopathy is the main cause of impaired vision in adults and one of the most common complications of type 2 diabetes.
It occurs when raised blood sugar damages the retina of the eye, the light-sensitive layer at the back of the eyeball.
This is because high sugar ultimately damages the blood vessels in the eye, and new, unstable vessels form that are prone to bleeding into the retina, causing inflammation.
The risk of diabetic retinopathy increases the longer you have diabetes, but it is also dependent on how controlled your blood sugar is.
however, even good control does not guarantee that retinal damage will not develop.
To have background retinopathy, as you have, means there are only minimal changes to your blood vessels. Most patients who develop diabetic retinopathy have no symptoms until the condition is very advanced.
Without action, the damage and leaking process can continue and cause vision loss.
The risk of this happening is one reason why people with diabetes must go to great lengths to maintain good blood sugar control. This means taking any medication, exercising, following a sensible diet and regular blood sugar monitoring.
A further test to help with this, called hbA1c, gives an average measure of blood sugar levels over the previous three months, and can give an even more accurate picture than usual tests. It is available at your GP surgery.
Second, blood pressure control is important. Aim for a reading of less than 140/90 to help minimise damage to the blood vessels in the eye.
Studies have confirmed this double-handed approach can help prevent retinopathy, or halt its progression.
In terms of your point about eating greens, other eye disorders, including cataracts and agerelated macular degeneration, are proven to occur less frequently in those who eat a diet rich in fruits and vegetables — these contain antioxidants that protect against eye damage.
In particular, pigments known as carotenoids ( lutein and zeaxanthin) protect the retina from the damage caused by ultraviolet light. You find these in spinach, kale, broccoli and lots of other vegetables.
Such a nutritious diet is not necessarily of benefit in respect of your diabetic retinopathy, but it is of overall benefit for your eyes and is very much to be encouraged.
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