THIS!!!! I was in the same position as many of you, started having this ridiculous pain, had some teeth removed only to have the pain continue. I started googling and lo and behold, I'm a full on Trigeminal Neuralgia patient. I wouldn't wish this on anyone---well, wait, there are a few folks---but this site has helped so much with making me feel like I'm not alone. My husband and family were 100% supportive but since none of them have TN they can't understand just what it was like. Now I'm 7 months out from a successful MVD and the memories of the pain are slowly starting to fade away. You can get to the point where your pain is either manageable or even non existant, you just need to keep the faith. Good luck to all!
I have not been on this site for quite sometime. But this is excellent information for any new person to TN. It is hard for those who do not have insurance to seek help, especially from neurologist and surgeons, but, my advice would be to find a very good primary care physician who is willing to help you with medications for TN. I also have had a recent problem in regards to insurance. We had to purchase new medical insurance and the company told me they would not cover, 'ever', anything involving my TN problem. So it can be scary, but, there are Primary Dr.s out there that will help you. Plus, surgery was a life saver for me two years ago, I was so afraid, but, from support from others, I had the surgery and it has been wonderful, so, do not be afraid to try getting relief from a very qualified Neurosurgeon who is very familiar with TN , do your research and use the internet. Read the advice on this site and others it is so helpful.
Linda, thank you for the advice, I am going prepared to my neuro with lots of ideas for other meds and possibly numbing creams or lidocaine patches. I am going to ask for an MRI, this is has been going on for over a year and only got very worse, does behave more like atypical trigeminal neuralgia type 2. I had remission of this facial pain for over 20 years, this is what this does do so it must be that type. And I have the list of doctors in my area of south Florida that specialize in this, if my neuro can't figure it out for me I am going to ask for a referral, I will have to travel some but that's ok. This site is very beneficial for anything you need to know, the neuros should read some of these entries and get a good education on this thing but we know they won't. Thanks, Sharon
Linda Kindle said:
I have not been on this site for quite sometime. But this is excellent information for any new person to TN. It is hard for those who do not have insurance to seek help, especially from neurologist and surgeons, but, my advice would be to find a very good primary care physician who is willing to help you with medications for TN. I also have had a recent problem in regards to insurance. We had to purchase new medical insurance and the company told me they would not cover, 'ever', anything involving my TN problem. So it can be scary, but, there are Primary Dr.s out there that will help you. Plus, surgery was a life saver for me two years ago, I was so afraid, but, from support from others, I had the surgery and it has been wonderful, so, do not be afraid to try getting relief from a very qualified Neurosurgeon who is very familiar with TN , do your research and use the internet. Read the advice on this site and others it is so helpful.
Bump!
Thanks to all the great advice I got by reading so many of these posts. I finally got into a neurologist and was able to ask the right questions. I have an MRI scheduled in 2 weeks. Currently it appears mine is geniculate neuralgia, instead of TN. But I wouldn't have even known about that if it wasn't for this site. Thanks!
Hello Richard, this post about geniculate neuralgia is very interesting to me. I think I may have a combination of atypical trigemingal, glossopharyngeal neuralgia and this neuralgia you just explained causes ear pain, not always the stabbing pain, only when I chew sometimes...but I do get some other unexplained symptoms. I just googled this one and it says you can have a bitter taste in your mouth, it is the roof of my mouth that burns and gives me a bitter taste. I have tried mouth washes, toothpastes for dry mouth prescribed by my dentist but nothing seems to help it. Sometimes the atypical trigeminal neuralgia switches intensity from one side of my head and face to the other.
I emailed my symptoms to a neurosurgeon on the list in Orlando and they responded. They would like my neuro or neurosurgeon to order an MRI of the brain and cervical to review. Still waiting for one of them to order this.
I just failed on a cream with lidocaine, gabapentin, ketamine and clonidine for my face. I have failed on 3 meds, first I get some initial relief but then it wanes but by the time I get to a therapeutic dose the side effects are overwhelming, vomiting and swelling of my lower extremites. I have done rhizotomy of some levels of my cervical spine, botox of muscles of the neck and scalp, months of PT and after a year I have only worsened, now I get a feeling like I have been slapped on the side of my head and face, my ears feel like they are being pinched and I have a plugged feeling, some tinnitus, vertigo and there is always pain in my neck, shoulders and also throbbing pain with a strange numbness and tingling at the base of my skull. I am fused at 3 levels, severe arthritis now, one bulged disk at c7-c8, tmj surgery in '86, so I get thrown under the bus as all these conditions may be creating this facial pain. I did not have this until a year ago. I did have some atypical facial pain from '86 to '96 and then it went away, I guess you could call this remission. My neuro's PA that just saw me left me with a response that maybe it will simply go away again. That would be nice. Trying to get an MRI out of my doctors has not been easy. I have been asking for months now. I begged for one from my neuro's PA, I will be seeing my neuro for more botox next month but he does not like you to talk in procedure. It is time to take a look at an MRI. I have read the surgical outcome for atypical trigeminal neuralgia type 2 is not as favorable and some of the other procedures can sometimes make it worse so I will cautiously approach invasive surgical procedures but I want the option.
Thanks for this post, today I will call a second time to try and get an order for an MRI. Sharon
Richard A. "Red" Lawhern said:
A couple of cautionary notes, if I may.
JSSlowboat, et al -- sharp pain "only"deep in the ear or associated with a samdtabbing pain back into the rear of the head lines up pretty well with a combination of two neuralgias: Occipital, which affects the rear quardrant of the head, and geniculate or "nervus intermedius" which results from a compression of a nerve which branches between the 7th and 8th (??) cranial nerves. These variations on vascular compression syndromes are worth discussing with your neurologist or neurosurgeon. Both have been effectively treated with micro-vascular decompression, but from what I've heard and read from patients, neither variant is particularly responsive to Gamma Knife, Cyber Knife, or Glycerol Rhizotomy. That is something on which a neurosurgeon's experienced opinion will be important to obtain up front.
For Albee: GK, CK, and glycerol rhizotomy do have a place in treatment of pain in the face. Of the three, Glycerol is possibly the least damaging. It has an average persistence of between one and two years of pain reduction when it works, and it can be repeated. GK and CK can only be done twice in a lifetime. The published practice standards for GK indicate that pain recurs within three years for about half of all successful GK patients, with further recurrences after that. From sources other than the practice standard I have also read that these procedures are also "mis-labeled" as non-invasive. While papers in medical literature indicate that MVD can be performed as a second procedure after GK, in many cases it will be made more complex by lesions and adhesions on and to the nerve, which are produced by the GK.Cyber Knife is also less precise than Gamma Knife, with about four times the spill-over of radiation into areas nearby the nerve (within millimeters). When "nearby" is the brain stem, I would personally have profound reservations about safety of this procedure. It was originally developed for cancer treatment in situations where invasive surgery was not feasible. I believe both procedures should be reserved for such situations when the target disorder is TN rather than cancer.
My two Red cents, for whatever they're worth.
Regards and best,
Red Lawhern, Ph.D.
Resident Research Analyst,
Living With TN
Richard, you are so very helpful with information of correct diagnosis for all these types of head and facial pain. Can you answer a question for me. At the same time about a year into all of this new pain with my face, neck and jaw, also the mouth pain my blood pressure was suddenly out of control. My primary had to double the strength. Over the past few years I have had intermittent problems with my blood pressure. I have read about this occurring but don't remember which site I googled. Is there a relationship between the worsening facial pain, usually one-sided affecting the face, head and stabbing pains in my jaw, also that ear pain, chewing aggravates it if I am having an episode, even a touch to a trigger point of pain along my jaw will cause the spasm all the way up the side of face to my cheeks and eye and blood pressure spikes? Thank you, Sharon.
jslowboat said:
That is VERY helpful, thank you.
Richard A. "Red" Lawhern said:A couple of cautionary notes, if I may.
JSSlowboat, et al -- sharp pain "only"deep in the ear or associated with a stabbing pain back into the rear of the head lines up pretty well with a combination of two neuralgias: Occipital, which affects the rear quardrant of the head, and geniculate or "nervus intermedius" which results from a compression of a nerve which branches between the 7th and 8th (??) cranial nerves. These variations on vascular compression syndromes are worth discussing with your neurologist or neurosurgeon. Both have been effectively treated with micro-vascular decompression, but from what I've heard and read from patients, neither variant is particularly responsive to Gamma Knife, Cyber Knife, or Glycerol Rhizotomy. That is something on which a neurosurgeon's experienced opinion will be important to obtain up front.
For Albee: GK, CK, and glycerol rhizotomy do have a place in treatment of pain in the face. Of the three, Glycerol is possibly the least damaging. It has an average persistence of between one and two years of pain reduction when it works, and it can be repeated. GK and CK can only be done twice in a lifetime. The published practice standards for GK indicate that pain recurs within three years for about half of all successful GK patients, with further recurrences after that. From sources other than the practice standard I have also read that these procedures are also "mis-labeled" as non-invasive. While papers in medical literature indicate that MVD can be performed as a second procedure after GK, in many cases it will be made more complex by lesions and adhesions on and to the nerve, which are produced by the GK.Cyber Knife is also less precise than Gamma Knife, with about four times the spill-over of radiation into areas nearby the nerve (within millimeters). When "nearby" is the brain stem, I would personally have profound reservations about safety of this procedure. It was originally developed for cancer treatment in situations where invasive surgery was not feasible. I believe both procedures should be reserved for such situations when the target disorder is TN rather than cancer.
My two Red cents, for whatever they're worth.
Regards and best,
Red Lawhern, Ph.D.
Resident Research Analyst,
Living With TN
Granny said:
Richard, you are so very helpful with information of correct diagnosis for all these types of head and facial pain. Can you answer a question for me. At the same time about a year into all of this new pain with my face, neck and jaw, also the mouth pain my blood pressure was suddenly out of control. My primary had to double the strength. Over the past few years I have had intermittent problems with my blood pressure. I have read about this occurring but don't remember which site I googled. Is there a relationship between the worsening facial pain, usually one-sided affecting the face, head and stabbing pains in my jaw, also that ear pain, chewing aggravates it if I am having an episode, even a touch to a trigger point of pain along my jaw will cause the spasm all the way up the side of face to my cheeks and eye and blood pressure spikes? Thank you, Sharon.
Granny, there can be a connection between chronic face pain and spikes in blood pressure. There are published papers indicating that some cases of high blood pressure may result from veins or arteries compressing a nerve ganglion. Though the procedure isn't common, MVD has been successful in addressing a few of these cases.
Conversely, it is known that some patients react to severe or chronic pain with higher blood pressure, and that stress can produce similar spikes. So there is a potential relationship to be investigated and assessed -- though I can't say with any authority that cause and effect are well understood in patients who have your symptoms.
I hope this gives you a starting point for talking with the doctor who supervises your high blood pressure medication.
Regards and Best,
Red
Bump!
Sharon, I live in South Florida and was wondering if you could let me know which doctors in the are are experienced with TN. Actually i do not have a diagnosis yet but think i have ATN. The nuerologist I went to doesn't seem to want to deal with my pain and told me to go to a pain doctor. I really would like to know if i have ATN or something else. I am going to someone at a oralo/facial pain cllinic in 10 days to see if they can give me a correct diagnosis. I am on 300mg of gabapentin which seems to have given me some relief but I heard you usually have to increase the dose because you get ed to it. I am having some side effects on this low dose and don't want to increase too f ast. i am seeing my GP tomorrow to ask him if he will monitor my doses but I really don't know if he will know how to increase it without me having worse side effects, Well, will go with a positive attitutde and hope he wil lknow what to do.I would still like the names of the South Florida nuerologists that you have. If you want the name of the clinic I am going to let me know. thank you so much and good luck to you.
Gizmo
Granny said:
Linda, thank you for the advice, I am going prepared to my neuro with lots of ideas for other meds and possibly numbing creams or lidocaine patches. I am going to ask for an MRI, this is has been going on for over a year and only got very worse, does behave more like atypical trigeminal neuralgia type 2. I had remission of this facial pain for over 20 years, this is what this does do so it must be that type. And I have the list of doctors in my area of south Florida that specialize in this, if my neuro can't figure it out for me I am going to ask for a referral, I will have to travel some but that's ok. This site is very beneficial for anything you need to know, the neuros should read some of these entries and get a good education on this thing but we know they won't. Thanks, Sharon
Linda Kindle said:I have not been on this site for quite sometime. But this is excellent information for any new person to TN. It is hard for those who do not have insurance to seek help, especially from neurologist and surgeons, but, my advice would be to find a very good primary care physician who is willing to help you with medications for TN. I also have had a recent problem in regards to insurance. We had to purchase new medical insurance and the company told me they would not cover, 'ever', anything involving my TN problem. So it can be scary, but, there are Primary Dr.s out there that will help you. Plus, surgery was a life saver for me two years ago, I was so afraid, but, from support from others, I had the surgery and it has been wonderful, so, do not be afraid to try getting relief from a very qualified Neurosurgeon who is very familiar with TN , do your research and use the internet. Read the advice on this site and others it is so helpful.
Gizmo, I do like the neuro I see, he is trying botox for me, lasttime he did it in my scalp area and I did get some pain relief, but only for a few days, first time he did the scalp. I see him again this month for more botox, we may be on to something that might help me. Also, I too can not take high doses of all these drugs because of side effects, like vomiting on tegretol, and increased swelling of my lower extremities on all the others if we raise the dosage. I am being maintained on a low dose of gabapentin 300 mg. 3x, can't raise it because I will start to swell. Most of these meds seem to help initially then wane and then along comes the side effects. I just started baclofen but the P. A. is not giving me a high enough dosage, going to ask to get that raised. I am also going to request an MRI again, there is one of the doctors on this list in Orlando that will see me but they want an MRI less than 6 months old. This is a very difficult pain condition to treat, I think my docs just give me little cookie bites of something to get me out until the next appointment. If my neuro gets something going with the botox in the right areas I will post my results and offer his name as a treating neuro in SW Florida. Good luck to you..Sharon
Red, thank you for the info regarding blood pressure spikes...I will mention this to my neuro. I do want an MRI, it has been over a year and I have exhausted so many meds, and procedures, rhizotomy, botox, and months of P. T. for the neck. Sharon
Sharon, i hope you get good results with the new nuero. I am looking for a good nuero in south east florida. The only one on the doctors list on the website is a nuerosurgeon. Do you know of anyone in my area? The nuero I went to was horrible and I don't want to go to another one like him. Good luck!!
Gizmo
Granny said:
Gizmo, I do like the neuro I see, he is trying botox for me, lasttime he did it in my scalp area and I did get some pain relief, but only for a few days, first time he did the scalp. I see him again this month for more botox, we may be on to something that might help me. Also, I too can not take high doses of all these drugs because of side effects, like vomiting on tegretol, and increased swelling of my lower extremities on all the others if we raise the dosage. I am being maintained on a low dose of gabapentin 300 mg. 3x, can't raise it because I will start to swell. Most of these meds seem to help initially then wane and then along comes the side effects. I just started baclofen but the P. A. is not giving me a high enough dosage, going to ask to get that raised. I am also going to request an MRI again, there is one of the doctors on this list in Orlando that will see me but they want an MRI less than 6 months old. This is a very difficult pain condition to treat, I think my docs just give me little cookie bites of something to get me out until the next appointment. If my neuro gets something going with the botox in the right areas I will post my results and offer his name as a treating neuro in SW Florida. Good luck to you..Sharon
Hello support group, Hooray, hooray for today, I finally got my neuro to order an MRI of the brain and also the cervical! I am going to continue with botox as he was on to something doing my scalp and I also am going to try ear drops for my ear pain, found someone similar to me on another site that uses tea oil or St. John's Wart oil, worth a try....now just because I am finally getting an MRI even if there are findings does not mean I will run off to surgery just yet because I did see some improvement with the botox in the scalp. Today he doubled the dose of botox to that area. Because I am most likely ATN, surgery does not always improve, can make it worse so all I want to do is rule out and go from there.
Thank you support group, all of you that have responded and even those who read we are all getting somewhere just letting some of it go, I read all of the posts I get an email on and if I can offer something I do. To you Gizmo I hope you find a good neuro, this one I have is wonderful, a real nice man too, has a heart of gold...if you ever want his name and want to come to Sarasota I would gladly give you his name. One thing though, he specializes in what he does which is botox, he did not know what an MVD was so when I get my results I know he will be able to read the results but anyway just so you know, I was a little puzzled about that. He is not a neurosurgeon, they simply get zoned in what they do. Surely he will know if I need to be referred to a neuro. Also all I had to do was email a neurosurgeon in Orlando, Melvin Field, he is on the list, they responded asking my doctor to order an MRI of the brain and cervical, I took this email to my neuro and he did it. Ok, off to lunch and down time, and to everyone who suffers may you have a day of some pain free hours even if I don't, just knowing someone has found some measure of relief is encouraging to me. Sharon
Glad you had your MRI's done and hoping you get good results. I am going to the oral faciaal clinic Tuesday to see if they can diagnose my problem. I am getting some relief with 300mg gabapentin per day but it in very inconsistent. I don't knbow if that means I have TN or if gabapentin will also help tooth pain. I alsohope they can refer me to a good nuero in my area since I have no idea who to go to. Hope you are getting relief with the botox.
Granny said:
Hello support group, Hooray, hooray for today, I finally got my neuro to order an MRI of the brain and also the cervical! I am going to continue with botox as he was on to something doing my scalp and I also am going to try ear drops for my ear pain, found someone similar to me on another site that uses tea oil or St. John's Wart oil, worth a try....now just because I am finally getting an MRI even if there are findings does not mean I will run off to surgery just yet because I did see some improvement with the botox in the scalp. Today he doubled the dose of botox to that area. Because I am most likely ATN, surgery does not always improve, can make it worse so all I want to do is rule out and go from there.
Thank you support group, all of you that have responded and even those who read we are all getting somewhere just letting some of it go, I read all of the posts I get an email on and if I can offer something I do. To you Gizmo I hope you find a good neuro, this one I have is wonderful, a real nice man too, has a heart of gold...if you ever want his name and want to come to Sarasota I would gladly give you his name. One thing though, he specializes in what he does which is botox, he did not know what an MVD was so when I get my results I know he will be able to read the results but anyway just so you know, I was a little puzzled about that. He is not a neurosurgeon, they simply get zoned in what they do. Surely he will know if I need to be referred to a neuro. Also all I had to do was email a neurosurgeon in Orlando, Melvin Field, he is on the list, they responded asking my doctor to order an MRI of the brain and cervical, I took this email to my neuro and he did it. Ok, off to lunch and down time, and to everyone who suffers may you have a day of some pain free hours even if I don't, just knowing someone has found some measure of relief is encouraging to me. Sharon
Hello Gizmo, I see where you are going, it looks to be more like a specialist is TMJ, but who knows with the facial thing, which does happen with TMJ they may have some ideas about where the root of pain is coming from. Now my neuro is good but still does the same 'ol try medications first, procedures with a pain management doc, his botox has helped, just wish it would last. But what he does do is listen, he even pulled a book about about nerve distributions to the face, this is such a complex issue, sometimes even they need to refresh themselves on all these nerves, some of the pain could be cervical but also looking for TN. He is a younger doctor, his name is Gregory Hanes in Sarasota, when I am not in procedure I see his P. A. I do understand the meds, I too do not tolerate all those anti-convulsants, now I am trying baclofen, we just upped the dosage. I can tolerate that one, was on it before. Google some your neuros in your area, that is how I found this doc, I wanted to try botox because I am fused at 3 levels in the cervical and do have a lot of muscle problems. This whole pain syndrome gets very complex when it is muscle and nerve, muscles can aggravate those nerves, arthritis can also cause a lot of inflammation and thus spasm and pain, I am 57, have lots of arthritis in my cervical spine. I know we all want direct answers for a med that will work, a procedure, but it is a trial of many things to try. Yesterday we discussed RF as a possible treatment, I have had rhizotomy of the cervical spine but that did not help, actually caused me more pain before it wore off. Never give up as our treating physicians do learn from trial and error, if one drug doesn't help there is always another to try and other procedures. I actually found a clinic up in NJ, to good to be true but a lot of testimonials of many who suffer that have found relief from this pain clinic, not sure if he is neuro too. I will have to travel to Orlando if I am referred to a neurosurgeon, and it is worth the travel, only about 5 in Florida really specialize in it. Recommended on this site too. Getting a doctor to really listen is hard to find, mine does listen. Sorry about this opinion but too many women get the it's all in your head or we are hormonal or too emotional and bring it on ourselves. Emotional stress will aggravate this condition. Good luck at this clinic, it is worth a try, I have tmj too, but a regular dentist that treats it does not always know when it is also something else with ATN or TN. And thank you for the encouragement, I am hoping for a better day after botox, sometimes it can take 2 weeks to see to full result, be patient, stay calm, and keep posting and know you are being listened too by all who contribute to this group. Sharon
I am new to this site and am very grateful the above information. I have read a lot of technical information and have a good medical understanding of TN, ATN, and GPN, but it really profound to read this info when it comes from the heart, so thanks to all who make such a huge effort. I want to add something for those, who like me, live alone in a rural area. I live on a small island with a population of less than 400 and have to travel for everything. I have a close neighbour who is fairly understanding but she is not always here. I sometimes have been worried about a late night crisis with pain. So two weeks ago, I sat down with the Volunteer Firefighter and First Responders Chief and carefully explained my situation and told her about my medications, etc. I couldn’t believe how relieved I felt after we had this discussion and she was pleased that I had come forward and very interested in learning something new. Next week I see my neurologist in Vancouver and will also get a crisis plan from her.
Thanks for your input Bellalarke. I've long encouraged people who live in rural areas to develop relationships in advance of need with local Sheriff's or volunteer fire fighter departments, so as to be able to call upon help for getting to a hospital emergency room if that measure is ever needed. We also provide an "Attending Physician Advisory Worksheet" as one entry under the Face Pain Info tab of our menus. The Advisory allows you to record your medical profile when you are having one of the better days, for possible use if you are so badly affected that you may not be clear or precise in your language when interacting with a medical professional. We've heard back from several patients who have been helped to get more timely assistance because they pre-recorded the information and then used it in a time of need.
Go in Peace and Power
Red Lawhern, Ph.D.
Resident Research Analyst, Living With TN
Thanks so much for the confirmation, Red. And also all the work you have done for the site. You are a dedicated and kind man. I have been going through your Fact sheets and am in the process of putting my binder together. I also ordered a Medic Alert bracelet this week. Just putting some order to the chaos and confusion and pain is as important as what’s in the medicine cabinet.
Richard A. “Red” Lawhern said:
Thanks for your input Bellalarke. I’ve long encouraged people who live in rural areas to develop relationships in advance of need with local Sheriff’s or volunteer fire fighter departments, so as to be able to call upon help for getting to a hospital emergency room if that measure is ever needed. We also provide an “Attending Physician Advisory Worksheet” as one entry under the Face Pain Info tab of our menus. The Advisory allows you to record your medical profile when you are having one of the better days, for possible use if you are so badly affected that you may not be clear or precise in your language when interacting with a medical professional. We’ve heard back from several patients who have been helped to get more timely assistance because they pre-recorded the information and then used it in a time of need.
Go in Peace and Power
Red Lawhern, Ph.D.
Resident Research Analyst, Living With TN
Hi Sharon, I don't think it is TMJ because my burning pain seems to be coming from one tooth. I also sometimes get burningin the upper and lower front teeth, gums and palatte. Sometimes it feels like my gums and palatte and swollen but since I am on the gabapentin it hasn't been bad. I also have neck and back issues but it is strange that I have not been having any probems for a while. I never thought that the back or neck could cause pain in your teeth. Well. in a few days I will be at the oral/fcial clinic and pray they will at least have a diagnosis for me. It seems like a lot of people take baclofen but I have never heard of it. If have to increase the gabapentin and have issues with t I will ask about the baclofen, Thank you for you encouragement. I will let you know what happens after I go to the clinic.
Gizmo
Hello Gizmo, I see where you are going, it looks to be more like a specialist is TMJ, but who knows with the facial thing, which does happen with TMJ they may have some ideas about where the root of pain is coming from. Now my neuro is good but still does the same 'ol try medications first, procedures with a pain management doc, his botox has helped, just wish it would last. But what he does do is listen, he even pulled a book about about nerve distributions to the face, this is such a complex issue, sometimes even they need to refresh themselves on all these nerves, some of the pain could be cervical but also looking for TN. He is a younger doctor, his name is Gregory Hanes in Sarasota, when I am not in procedure I see his P. A. I do understand the meds, I too do not tolerate all those anti-convulsants, now I am trying baclofen, we just upped the dosage. I can tolerate that one, was on it before. Google some your neuros in your area, that is how I found this doc, I wanted to try botox because I am fused at 3 levels in the cervical and do have a lot of muscle problems. This whole pain syndrome gets very complex when it is muscle and nerve, muscles can aggravate those nerves, arthritis can also cause a lot of inflammation and thus spasm and pain, I am 57, have lots of arthritis in my cervical spine. I know we all want direct answers for a med that will work, a procedure, but it is a trial of many things to try. Yesterday we discussed RF as a possible treatment, I have had rhizotomy of the cervical spine but that did not help, actually caused me more pain before it wore off. Never give up as our treating physicians do learn from trial and error, if one drug doesn't help there is always another to try and other procedures. I actually found a clinic up in NJ, to good to be true but a lot of testimonials of many who suffer that have found relief from this pain clinic, not sure if he is neuro too. I will have to travel to Orlando if I am referred to a neurosurgeon, and it is worth the travel, only about 5 in Florida really specialize in it. Recommended on this site too. Getting a doctor to really listen is hard to find, mine does listen. Sorry about this opinion but too many women get the it's all in your head or we are hormonal or too emotional and bring it on ourselves. Emotional stress will aggravate this condition. Good luck at this clinic, it is worth a try, I have tmj too, but a regular dentist that treats it does not always know when it is also something else with ATN or TN. And thank you for the encouragement, I am hoping for a better day after botox, sometimes it can take 2 weeks to see to full result, be patient, stay calm, and keep posting and know you are being listened too by all who contribute to this group. Sharon