My ATN started after I got a tooth pulled (upper right). Started as phantom tooth pain, then headache on that side. Over 6 months it “evolved” to tooth pain, headache, jaw stabs, and tightness around my right eye. Headache in the back of my head is still the most troublesome symptom. Does anyone else experience ATN pain with primary headache symptom?
Many folk report TN after dental treatment, it used to be a question on sign up, unsure about these days. As a primary pain, I’d consider addressing it with some sort of physical therapy before other. Dental extraction does place stress on your neck and it would appear you might have symptoms of occipital neuralgia, bearing in mind your eye pain. This neck dysfunction can also cause tooth pain.
As a consideration this could be potentially great news, as conservative treatment can lead to great results. Not offering a diagnosis but a consideration.
Using the search function above may yield similar stories.
Wishing you well
When I did a demographic analysis on 1800+ members here about four years ago, I found 600+ member profiles where dental work appeared to be associated with the first emergence of pain. Among some of those members, migraine, cluster headache, and/or tension headaches were also a part of the pain pattern.
The headache evolution that you mention could be related to the emergence of two different forms of neuralgia, one affecting the 5th cranial nerve (ATN), and the other involving the greater occipital nerve which branches from the spinal column near Cervical disc one and two (Occipital Neuralgia).
Thank you. I am happy to report that Botox has taken the daily headache from a 7 down to a 0-2 on the pain scale. As far as the emerging facial symptoms, I do agree they are separate from the occipital portion. I’m still searching for relief on the front end as the pain is changing and now including internal ear pain (oddly, Advil works wonders). I live near Philadelphia and have access to some very informative doctors in this field. Two of them suggest that the CNS is “all connected” like highways and roads. They seem to think I experienced peripheral nerve damage. The docs at University of Penn think it was a malfunction in the way the brain perceives pain when the tooth was pulled. Anxiety and depression can be a precursor to this as the CNS is already malfunctioning. I also have a lot of dental work - it could be that the trigeminal nerve can only take so many novocaine shots in a lifetime. They diagnosed me with Atypical Facial Pain.
As much as I want to agree with “nerve damage”, I do think it’s Atypical Trigeminal Neuralgia plus occipital neuralgia. I do have certain triggers in the mental nerve (talking a lot, some fabrics, etc). It can be electric at times, but not that painful - more annoying. My trigeminal MRI is normal - no abnormal vessels in the brainstem.
I appreciate your input. It really means a lot. I hope when I learn enough about this condition, I can help people like myself. It can be very lonely and hard to understand. It has turned my life upside down. I’ve yet to find a doctor who offers multi-faceted care for this condition (physical and mental).
Side note:
Prior to having the tooth pulled, I had MRSA in my ethmoid sinus on the same side. This caused me tremendous stress. I had the tooth pulled because it hurt sometimes when I applied pressure. (I have to laugh about this “pain” from the past when I think about it compared to today) It was in fact infected (fractured root canal). I feared that it had something to do with the sinus infection so out it came.
The term “Atypical Facial Pain” is no longer being generally used by experts in this field, Meldaver. It is basically equivalent to “be damned if I know what’s going on here - it doesn’t fit any of the patterns generally recognized.”. The internal ear pain may possibly be associated with yet a third form and location of neuralgia – so-called “Nervus Intermediuis” Neuralgia or “Geniculate” Neuralgia.
The common term “nerve damage” is not necessarily a contradiction to the term “atypical trigeminal neuralgia”. The general trend in classification for facial pain that doesn’t have a discrete and definitive “cause” like microvascular compression of the nerve, is toward “trigeminal neuropathic pain”. We’re seeing this latter term used increasingly among medical professionals.
Thus it is entirely possible that you have indeed experienced peripheral nerve damage during dental work, which has evolved over time into something more related to the central nervous system. This can occur in patients who ALSO have compressions of multiple nerves by blood vessels. It’s not an either/or deal.
Evaluation of your overall pain patterns might be greatly aided by going through a FIESTA MRA with special weightings used to highlight areas around the trigeminal nerve and nervus intermedius, to look for compressions of both.
Best regards,
Red
Hi Red1,
I had an MRI that focused on thin slices (Sagittal T1, axial T2, FLAIR, and diffusion weighted images) of the right trigeminal area. No compressions were seen. Maybe a FIESTA is better. Are compressions always seen on MRI?
As far as classification, it’s really confusing. I’m not considered a “spontaneous” case because trauma preceded the pain. I had no dental pain prior to the tooth extraction. A cracked and infected root canal failed the tap test. So, according to TN1 and TN2 definitions - they are spontaneous without any prior trauma - not me.
I’m seeing a neurologist who specializes in facial pain in February. Trigeminal Neuropathic Pain is definitely my category. I’ve never heard of the nerves intermedius - I will ask the doctor all these things.
Thanks for helping me navigate this.
It’s common for compressions to be found during the exploration phase of a Microvascular Decompression procedure, that weren’t seen in imaging previously. This is true even of “thin-slice” MRI images, though less common at these higher resolutions. However, what you are describing does seem to fit the diagnostic category of Trigeminal Neuropathic Pain.
In the demographics study I did four years ago on this site, about a quarter to a third of our membership at the time reported their first emergence of protracted face pain following a dental procedure. It’s entirely possible that some of these cases were coincidental rather than causal. However, it was remarkable that dentists in general practice rarely recognized that they were seeing a non-dental issue, or referred their patients to a neurologist.
The Nervus Intermedius is a nerve branch between the seventh and eighth cranial nerves. To quote from Wikipedia,
“The intermediate nerve, nervus intermedius or nerve of Wrisberg, is the part of the facial nerve (cranial nerve VII) located between the motor component of the facial nerve and the vestibulocochlear nerve (cranial nerve VIII). It contains the sensory and parasympathetic fibers of the facial nerve. Upon reaching the facial canal, it joins with the motor root of the facial nerve at the geniculate ganglion.”
Do come back and share what you learn from your neurology appointment.
Regards, Red
Hello ,I have excruciating left side and back of head pains but never had any discomfort with face mouth or jaw and no detail check ups that have caused any pain it’s just this awful head pains neurologist has not come across anyone with my head pains like I get MRI shows some small blood vessel damage but that is normal as we age ,I did have a road traffic accident a few years back after being knocked off moped and knocked out but these heads came a couple of years after that,I’m on Trigeminal which makes me a zombie and weak but I’m full of hopes of improving and getting back my life again ,I just wish the consultant could give me an answer,does anyone have just severe head pains ongoing for weeks ,I’d like to know