Brief Answer:
Unlikely to be trigeminal neuralgia

Detailed Answer:
Thank you for your question. I am going to respond to the information you've put into your query with the disclaimer that my inability to see you physically is a disadvantage when trying to deduce what you actually HAVE as a diagnosis, however, let me respond to what you are describing.

1. Continuous pain in the RIGHT EYE GREATER THAN LEFT tells me that you are essentially complaining of pain on BOTH sides of the face but that one side is simply stronger than the other. You do not specify whether the pain is CONTINUOUS or does it calm down to NOTHING for a period of time before starting again? On the right side of the face is there is NASAL STUFFINESS/CONGESTION or nasal drip which is NOT on the left side? Also, is there any nausea/vomiting/oversensitivity to light, sound, or smells?

2. Trigeminal Neuralgia by definition is a lancinating pain of a sharp and electric nature that comes out of nowhere and lasts at most 1 second or more commonly FRACTIONS of seconds. There is no such thing as trigeminal neuralgia WITHOUT THIS TYPE of pain....no matter whether textbook or not. There is TRIGEMINAL NEUROPATHY and there is TRIGEMINAL NEURITIS. If in fact, your situation is a trigeminal neuritis then, the pain can be of a continuous nature and not necessarily triggered by anything unlike TRIGEMINAL NEURALGIA which often comes on after being triggered by something.

I will state once more than with all due respect to your neurologist's opinion...there is simply no such thing as a NEURALGIC PAIN that lasts for hours or continuously. However, a NEURITIS or a NEUROPATHY can have continuous types of pain....therefore, from what you describe trigeminal NEURALGIA for me is clearly OFF the table as a diagnosis.

Carbamazepine or Tegretol is clearly a very good choice for TRIGEMINAL NEURALGIA but one possible reason it's not working is because the diagnosis is not neuralgia. Carbamazine could certainly cause headaches as a side effect but not the type that you're describing. Not only that, my assumption is that you had this facial pain/headache BEFORE starting this medication, no? Wasn't the headache/facial pain the impetus to starting the drug? If so, I'm not certain I would place the medication in the middle of trying to explain what's causing the problem.

I believe that there is a possibility that in reducing the propranolol your headaches have ramped up. In other words, the beta blocker has been working to reduce the intensity of these headaches.

If your neurological examination is NORMAL as performed by the neurologist then, it doesn't XXXXXXX me that your imaging studies are without remark. But at the very least you can definitely rule out things such as aneurysms and other intracranial pathology.

As a headache specialist my patients always fill out headache diaries which I analyze and review with them with respect to a number of different parameters. Before we know what the treatment should be a good diagnosis needs to be made. In your case, I don't believe the right diagnosis has been made. It certainly doesn't seem as if you've been tried on too many different regimens except the 1 single beta blocker and the carbamazepine under the assumption that this was a trigeminal neuralgia that would have to be absolutely the most ATYPICAL one under the circumstance.

I would request that your primary doctor or your neurologist refer you to a headache center or specialist. This will be your best chance at getting a proper diagnosis and again, this with due respect to your neurologist but if these pains have been present since Easter and the only thing that's been tried has been the propranolol and carbamazepine then, my guess is that the diagnosis is quite elusive to your doctor. Time to let someone else take their best effort.

If I were to take a best educated guess on your headaches I would put these down as CHRONIC DAILY HEADACHES which may be in an antiquated vernacular "transformed" migraines. To the next doctor taking care of these I would ask whether or not a calcium "channelopathy" could be afoot and I might even consider your headaches as being a result potentially of a magnesium deficiency.

CAUTION: Please do not take these ideas as an invitation for you to go out and start looking for calcium and magnesium from the nearest Vitamin Shoppe because it's more complex than that.....PLUS, as I said initially, I don't have the advantage of having examined or tested you.

Virginia's not the far from XXXXXXX Ohio if you've got any free time to take a road trip! :)

Bottom Line: You need a SOLID DIAGNOSIS as well as a treating physician who is going to be more proactive/agressive in terms of adjusting treatments/interventions more quickly and readily when it's apparent that one approach is not working to satisfaction. And I highly recommend use of a HEADACHE DIARY.

If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my answers/suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 36 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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Brief Answer:
Thank you for your clarifications

Detailed Answer:
Your response supports my proposed classification of CHRONIC DAILY headaches....looks like there's a history of 23 years....TRIGEMINAL NEURALGIA in the way you described would be entirely unknown under such a time constraint. I'm really not clear on the impetus of the neurologist who prescribed carbamazepine for this problem. I do understand the propranolol and that makes sense. However, at the point that it became clear that neither agent was really beneficial I would've withdrawn the drug and looked for another solution.

It is quite possible and even likely by what you describe that the propranolol is having some positive effect on the intensity of the headaches but notwithstanding the job of the medication is not to just "make it better" but we can only consider it a success if the headaches are COMPLETELY ERADICATED, meaning an intensity of 0/10 and a frequency of 0/month.

Without a headache diary and/or other form of documenting exactly when you started these medications compared to the path of escalation of your headaches I think it is difficult at best to know whether the headaches are getting worse because of the medications as opposed to their getting worse simply based upon their own natural history of evolution versus some other as yet unidentified environmental or somatic trigger.

Again, going forward I would simply refer you back to what I'd written before regarding the utility of a HEADACHE DIARY or LOG and the importance of next seeing a physician specialized in the approach and treatment of headaches since it's high time these 23 year headaches get diagnosed and treated.

Your favor of CLOSING THE QUERY if I've sufficiently provided you with useful information and including positive words of feedback along with a 5 STAR rating if you feel my answers/suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 64 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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