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Ask the Expert: Numbness in the Face

Q. I have been suffering from numbness of the scalp, forehead and around my eye and nose. The numbness is predominantly right-sided and more pronounced when I wear my glasses and wipe my head with a towel. These symptoms have been intermittent for years. They last for weeks and can go into remission for weeks at a time.

I have been diagnosed with migraine, trigeminal neuralgia, cranial syndrome, cervicalgia and occipital neuralgia. The symptoms still persist despite trials of a number of medications.
A. From the history that you have presented, it seems that the intermittent numbness sensation you describe may not be related to migraine. In order to meet the diagnostic criteria for migraine, there needs to be associated symptoms, including nausea and/or vomiting and light and/or sound sensitivity. The symptoms usually worsen with physical exertion. In order to meet the diagnostic criteria for trigeminal neuralgia, there should be brief electric shock-like pain that is limited to the distribution of one or more divisions of the trigeminal nerve. The pain is usually evoked by normal daily activities including washing, shaving, brushing the teeth, and smoking.

Sometimes, when a headache diagnosis is not completely discernible, it may be worthwhile to combine preventive medications including a tricyclic antidepressant and an antiseizure medication. Other alternative modalities of treatment include biofeedback and stress relaxation training, craniosacral therapy, acupuncture, and upper cervical massage. These are not scientifically proven treatments but may help when medication therapy fails.

-George Nissan, D.O.
Diamond Headache Clinic, Chicago, IL

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