Hi I’ve had this pain come and go now for over 20 years. I am now 41. It was always considered to be sinus related. I have really small sinuses and I also have allergies. I’ve had 3 sinus surgeries to correct my small blocked sinuses and I can breathe really goodnow but I continue to have pain, pressure and burning attacks which can last up to 3 weeks. The pain, etc is always in the same locations, my nose along the sides of it. Sometimes my cheeks but mostly the deep aching pain and pressure is right on the bridge of my nose. Sometimes it actually feels numb.
My current ENT is one of the top guys in his field and teaches others and he now believes this pain is not sinuses related but neurogenic. I tend to get attacks after my allergies are triggered. My cheekbones swell up and my eyes. But once the swelling has subsided the pain just continues. I also in the beginning before an attack feel nauseated and not well. So at first we thought this was a type of facial migraine. But I did not respond to migraine medications.
I take tylenol and advil when I get these attacks but they just take the edge off a bit. My dr has now prescribed a capsicum spray for when my pain is peaking. It does halt the pain for about 20 minutes. But slowly it comes back.
He was going to prescribe amitriypline but I can’t take it because I’m on Paxil. I was thinking of trying Gabapentin.
I’m having a really hard time coming to terms with this not being sinus infections. But I saw on the endoscope there is no infection in my sinuses and they are not blocked. There was slight swelling on the right where I had more pain but nothing that would cause this amount of pain.
Sorry this is so long but it helps for me to write it out. I keep waking up at night thinking this has to be a sinus infection but logically I know it isn’t. The only time I am not in pain is when I’m asleep and for the first few moments of waking. Then it just starts in with pressure and pain. Like someone has put a really strong clothespin on the bridge of my nose. Or like something is trying to push its way out.
Its so strange though cause sometimes even if I barely touch my face the pressure gets so strong.
Hi Lynn,
Welcome, and sorry you are struggling with this. I do think many of the symptoms you are having seem indicative of neurogenic pain. For instance the pain and pressure going to numbness, the fact that typical OTC meds don’t work well for you, the fact that it goes away at night and starts up again in the morning, all are very typical patterns.
In my case, I found that pain meds only helped a tiny bit, but the rebound pain I got from them made them not worth it. This was especially true for opiods. You might try tracking your pain and see how it relates to different meds over time. I’m still working out how different supplements affect my pain levels.
If the capsicum spray works well for you, even if just briefly, I would encourage you to pursue the topical/spray remedies. Obviously the side effects from them are minimal compared to oral meds. I’ve had very good luck with a topical gel containing capsaicin, lidocaine, and I recently added diazepam–using a combination of drugs in these topicals is very usual. The topical is making my life much less miserable and I can go without oral pain meds. I can also go much longer between applications now than at the beginning.
I would also encourage you to look at all other ways you can promote healing. I think the fact that this just comes in spells bodes well, if you can keep the attacks at bay, you can get rid of this for once and for all.
Hi there,
I have a good friend who is a family physician, and his method of finding out if a particular pain is neurogenic or not is to try to see how well it responds to anticonvulsants (obviously this is only after other methods of diagnosis have failed).
So try gabapentin, if it helps then you know its neurogenic.
I think amitriptyline/nortriptyline are worth a try but if you are already using an SSRI it can be tricky.
One way is to take nortriptyline instead of amitriptyline. Nortriptyline doesnt have any affinity for seretonin neurotransmitters and so there wont be any chance of seretonin syndrome (as far as i know, but please double check with your doctor).
I am taking lexapro and i want to add nortriptyline.
Good luck, I also constantly struggle with a TN diagnosis. I always hope its anything but TN.
Thank you so much for your replies. It means a lot to me as this is quite a lonely place to be. Do you think the capsaicin spray builds up over time to work better? I guess what I mean is does it sometimes take several doses to work up?
I wish I wasn’t on paxil but I believe this pain is part of the reason I developed anxiety. Perhaps, managing the pain I might be able to reduce the antidepressent in the future.
Hi Lynn
Welcome to this board.People are so kind and knowledgeable and sympathetic here.We all in it together ,so we all try and say what works for us.I was on gabapentin before my mouth pain struck.For type 2 TN the anti-depressants are the go to drugs.For regular TN it is the anti-convulsants.That is what I think I know.They all mess with my memory though.
Hi Lynn. I am very sorry for your suffering with sinus issues. You said your ENT did not think your problem is a sinus infection or sinus related. But, you did not say he was SURE of that. Even if it is not sinus related, it is still affecting your sinuses. I have had sinus problems for many years due to a deviated septum & have found that Cat’s Claw bark is awesome. I use the tea & take capsules sometimes. If you do a search on it you will see how it is very good for sinus conditions. It has been a Godsend for me. Also, I use colloidal silver, spray & drops, for my sinuses as well. These are 2 natural products without side effects, I find, that may help you, even if your problem is not sinus related (the core reason for your problem). Blessings!
Thank you! I will check out cat’s claw bark. I have tried collodial silver with no success, unfortunately. I also find rinsing with saline and manuka honey helps. Thank you.
