Q: I am a 38 years old woman having facial pain on the right side including right cheek bone, brow and the right side of the upper forehead in which sometimes painful lumps appear and go away within a week. I also feel pain in the right ear and right eye, which sometimes becomes red and feels gritty. The right upper teeth also throb in pain. It has become very difficult for me to rest and sleep. I took Tylenol PM to sleep but lately, this has not been helping at all. Also, the right side of the top of the head has become very tender to touch and lumpy. Sometimes when I apply light pressure to these lumpy areas, there is a pop in the right nostril. The right side of the back of neck pains too. At times when I turn my head, my right ear pops. At times, there is pain in the right shoulder blade. I have slight vague headache, which is mostly a constant pain. Other symptoms are weakness, brainfog, hard to focus visually and mentally and sleeping difficulty. Please advise.

A:You are 38 years old and have symptoms, which superficially look like neuralgic pain involving the right side of face, eyes, ears and teeth. Although you have not mentioned about the exact duration of each pain episode, it is apparent that they are recurrent lasting for days to weeks. Are there any trigger points (that is, whether any specific part while being touched or stimulated starts the pain)? You also have scalp hyperalgesia (tenderness). Finally the lumps, which you describe, are difficult to explain. Could they be engorged vessels as some of them give you throbbing sensations? Overall your clinical picture suggests involvement of right sided trigeminal nerve (the nerve providing sensation to the facial area, scalp and teeth) and possibly either a vascular component or autonomic dysfunction of the same side. Since these are affecting your day to day working, I strongly suggest that you should take a good neurology consultation.