Question: I am a 50 yr old white female. Diagnosed with Trigeminal and Occipital neuralgia and undefined facial pain. Gabapentin was started and dc'd due to allergic reaction. Baclofen was then introduced and tolerated well at 10 mg/3x daily. Occipital flares have occurred 2x in Dec with one resulting in an ER visit and intravenous dilaudid introduced, two doses within an hour a part. Minimized but never diminished pain. I did have an MRI 10/4/06 when findings state: "Brain parenchyma shows a few scattered areas of increased signal intensity in the white matter that are felt to be nonspecific in nature. There are no mass lesions, extra-axial fluid collections, hemorrhage or other pathologic signal intensities. The ventricular system is of normal size and appearance. The pituitary gland is normal. Posterior fossa structures show a vascular structure at adjacent to the lateral portion of the left trigeminal nerve as it enters the brain stem. It appears to cause some compression of the trigeminal nerve."

Impression: 1. Vascular structure adjacent to the proximal portion of the left trigeminal nerve. This does appear to cause some distortion of the left trigeminal nerve. 2. Nonspecific white matter changes in both hemispheres.

My concern is the burning I have in my upper left, toward back of skull area. This is constant. The other symptom is nasal congestion that occurs with EXCESSIVE sneezing that is disruptive during the day and night. Decongestant tabs and loratadine is does not elicit a response from this symptom. Are there things that can occur simultaneously with TN and ON that can cause this anomaly and is white matter a concern? This does elevate my bp to 158/101 when I am a normal 117/70. thank you so much for your time!

What about Hemiacrania continua? The congestion, droopy lid and headache/facial pain could fall in this category correct? Is there a test or just ruling it in or out with Indemethacin.