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Diagnosis of Migraine & Headache Types

Headache Types

  • By iHold

    I had a question about neuralgia also. Specifically Occipital and Trigeminal Neuralgia. I’ve had chronic migraines for almost 10 years. Within the past 2 years I’ve noticed a difference in the pain. Is it possible to get neuralgia due to the chronic migraines? I’m having a hard time talking to my neurologist about this. He seems to not understand what I’m trying to explain. Any suggestions?

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  • By Ellen Schnakenberg

    iHold, Neuralgia is not well understood. Neither is facial pain and Migraine, although we do know there is an inflammatory component that can affect the nerves of the face. Usually this type of pain subsides with the Migraine however. This facial pain related to Migraine also doesn’t usually have triggers, such as eating, or a breeze on the face unless a Migraine is in progress.

    There are neurologists who specialize in neuralgia if you would like to rule that out. I’m not sure where you are, but you might try doing a search for “Trigeminal Neuralgia specialist” or “facial pain specialist” and the name of your state or surrounding states.

    If you would like a little more information on diagnosing TN, here is a fabulous link to a physician in Oregon who has an online diagnostic tool to see if you might suffer from TN. Take the printout to your doctor and begin a discussion about your answers. You can find that here: https://neurosurgery.ohsu.edu/tgn.php

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  • By Laura

    I’ve been searching for relief since 2004. Doctors previously have treated me for migraine or trigeminal autonomic cephalalgia (TAC) (I’ve tried numerous abortive and preventive meds – but I am still in pain). However a new neurologist just described my problem as atypical facial pain or a neuralgia. She says the pain is from the trigeminal nerve.

    My pain is above and behind my left eye and in my left cheek and feels like someone is pushing a pool stick through my face. It is constant (24/7) though it varies in intensity. Most days it is in the moderate range.

    However I also have other symptoms besides pain – though the other symptoms are not present all the time. I get the other non-pain symptoms 3 or 4 days a week. These symptoms include weakness, fatigue, brain fog and a sense of being disconnected.

    Has anyone experienced facial pain or trigeminal neuralgia along with non-pain symptoms? Is facial pain even considered a headache?

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  • By Ellen Schnakenberg

    Laura, I have facial neuralgias which are aggravated by Migraine and triggered by them as well.

    Here is a link that may help you figure out your facial pain situation. This is a diagnostic tool designed by one of the tops in the field. It is made for you to print out and give to your doctor to get a conversation going or provide you with reason to ask for a referral. Here is the link: https://neurosurgery.ohsu.edu/tgn.php

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  • By Anonymous

    It’s very true that you can have more than one type of head pain. Actually in my practice it’s the minority of patients that only get one headache diagnosis.

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  • By Laura

    Interesting. Can atypical facial pain or an atypical trigeminal neuralgia include non-pain symptoms such as fatigue, body weakness, and brain fog or inability to concentrate? Do neurologists or headache specialists consider facial pain to be a headache?

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  • By Anonymous

    Any type of pain above the shoulders to me is a headache. Facial pain is in the international headache classification.

    Atypical facial pain and trigeminal neuralgia shouldn’t have all of those other symptoms like brain fog and fatigue which means that it could be migraine. IN fact out of maybe 30 or so patients that have been referred to me for new trigeminal neuralgia, I have only truly diagnosed 1 because the rest were migraine. Location of the pain in migraine is not part of the criteria.

    And migraine is different not only between patients but also within patients. Not every migraine is going to be the same but they all have to be somewhat similar.

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  • By iHold

    Thank you Ellen and Dr Whyte. All this information is very helpful.

    I was able to find a Dr that understands neuralgia better. He says I have both migraines and TN. He did some facial nerve blocks and we’ve tried Tegretol to see if it makes a difference, and it does. (Those blocks were ridiculously painful but how I wish they worked permanently!) I’ve been sent to a neurosurgeon that specializes in TN to see what he can do.

    The Dr does wonder if my pseudotumor cerebri can be adding even more pressure on the 5th nerve, therefore causing more pain. It seems like Diamox and Aldactone aren’t cutting it. Any thoughts on the correlation between TN and pseudotumore cerebri?

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  • By Ellen Schnakenberg

    Hi iHold – I don’t know of any correlations between pseudotumor and TN, however, it does seem to logically make sense that there might be some kind of a relationship. It will be interesting to see what the neurosurgeon thinks about this. I hope you’ll get back with us and let us know what you’ve found out. 🙂

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