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Last month I experienced a dreadful pain on one side of my face – like an electric shock going from my upper lip to my hairline. It lasted a few seconds but stopped me in my tracks. I saw my GP who suggested it was trigeminal neuralgia, prescribed pregabalin and arranged an appointment with a neurologist. I’m frightened of the pain returning. Will it?
Trigeminal neuralgia is a sudden and severe facial pain. Attacks can last anywhere from seconds to a few minutes and can occur hundreds of times a day.
It’s related to problems with one of the trigeminal nerves, which run across either side of the face, branching from just in front of the ear, around the eyes and across the forehead and also the jaw. Usually just one is affected, so pain is felt on only one side of the face.
Trigeminal nerves transmit sensations of touch and pain, but they can become compressed – often by nearby blood vessels, for reasons that are not always clear – resulting in episodic pain.
Trigeminal neuralgia is a sudden and severe facial pain. Attacks can last anywhere from seconds to a few minutes and can occur hundreds of times a day
The attacks can be triggered by activities that involve touching the face, eating and brushing teeth. But a slight breeze or air conditioning, or movement of the face or head, can also bring it on.
We’d usually only diagnose it once there has been consistent or recurrent pain, but a GP might choose to prescribe something as a pre-emptive measure.
The most commonly given drug for trigeminal neuralgia is carbamazepine, which works to dull nerve pain. Pregabalin is also a nerve-pain drug, but isn’t usually given in these cases.
Looking for causes is an important next step – dental problems, for instance, can be linked. Patients should expect a referral to a specialist pain clinic – with waiting lists as they are at the moment, making sure the appointment is made might involve being persistent with the GP. In some severe cases, surgery is required.
A few years ago I was started on statins as my cholesterol was very high – 7.7. My levels didn’t come down enough, so I was switched on to another statin but this seemed to trigger intense anxiety. A third type caused the same problem. I’m only able to tolerate a low dose of the original statin, but this isn’t controlling my cholesterol. I have a family history of heart attacks, so I’m wondering if I have other options?
Very high cholesterol combined with a family history of heart attacks is a risky situation to be in.
Bringing down the cholesterol level would reduce the risk of a heart attack or stroke. But other things will also be important, including treating diabetes or raised blood sugar and high blood pressure. Regular exercise and making sure you are a healthy weight – with a waist measurement of less than 37in for men and 31in for women – are key to this.
Statins are very common drugs but there are side effects for some people. Anxiety isn’t a typical one we hear, but if it is something you are suffering then doctors should offer alternatives. If only a lower dose of statins is tolerable, there is the option of adding another type of a cholesterol-lowering drug called ezetimibe. Together they may help control cholesterol without the side effects.
Bringing down the cholesterol level would reduce the risk of a heart attack or stroke
In many hospitals there are specialist lipid clinics that focus on people who have very high cholesterol that is difficult to treat, and it may be worth asking for a referral to one as they can offer a range of other drug treatments that can’t be initiated by a GP.
The charity Heart UK can offer advice (heartuk.org.uk).
My six-month-old grandson has an inflamed rash all over his body. Our doctor has prescribed an antihistamine, which only reduced the redness. He is unable to sleep, which means neither can Mum and Dad. Can you offer any advice?
The first thing I’d consider is eczema. This causes inflamed, dry and red skin with episodes flaring up and then subsiding.
It’s common in babies, and we have fairly standard treatment regimes that we would offer parents. A warning – sticking to these can be tiresome and boring. It certainly can help a great deal, but only if it is consistent.
The first step is avoiding all irritants, such as bath products and shampoos and things that may affect the skin, including fabric conditioner. Speak to pharmacists about a suitable soap substitute – usually a cream or an oil rubbed on the skin.
At least three or four times every day (often when changing a nappy) an emollient cream should be used – these are medically formulated moisturisers which hydrate and soften the skin.
There are a number of options on chemists’ shelves and it may take some trial and error to find one that suits.
As well as this, when eczema is particularly flared-up, a few days of a mild steroid cream could be used in the worst areas.
This worries some patients, but these are extremely safe and definitely a better option than leaving a baby in pain from the rash.
Antihistamines generally don’t help eczema.
It’s worth considering a cow’s milk protein allergy. This can cause a severe eczema-type issue on the skin as well as digestive issues, and often babies with very inflamed skin actually have this, not eczema.
Weather warnings aren’t so daft
I rolled my eyes when I read about the Government’s plan to introduce a new system of colour-coded warnings to tell us when the weather gets really hot or really cold.
I’m sure, like me, you thought: ‘Well, I can work that out for myself, thank you very much.’ But us Brits are not so good in the heat. I know this because every summer I see sunburnt kids and elderly people with heatstroke in my clinic. And every year thousands of people die from the heat in the UK. It’s a serious problem, particularly in over-65s. Health concerns are an issue in winter, too, when temperatures drop.
So I’ll be signing up to the emails. You can register via the Government’s website (gov.uk). The easiest thing to do is to Google ‘Weather-Health Alerting System’ and it should come up as the top hit.
What women’s health issues do YOU want tackled now?
In August last year the Government launched its Women’s Health Strategy for England after spending a year gathering reports from women about their medical experiences.
There was a vast number of responses, with many telling stories of being ignored, dismissed and poorly treated. The Mail on Sunday is passionate about changing this – so we are assembling a Women’s Health Panel to tackle the biggest health problems facing 51 per cent of the population.
In the coming weeks, we’ll devote a whole edition of Health to answering in depth the most pressing issues you’re facing. You can email me on DrEllie@mailonsunday.co.uk or write to me at: The Mail on Sunday, 9 Derry Street, London W8 5HY
It will feature the UK’s foremost experts in a wide variety of medical specialities, from gynaecology and mental health to fitness and dermatology. Today, we have one question: What do YOU want us to talk about?
In the coming weeks, we’ll devote a whole edition of Health to answering in depth the most pressing issues you’re facing.
You can email me on DrEllie@mailonsunday.co.uk or write to me at: The Mail on Sunday, 9 Derry Street, London W8 5HY.
