.

Dale’s Black Eye Palsy, a Cause of Cluster Headaches Postulate

Dale Fairly,  November 21, 2016, first revision January 1, 2017


Definition

  Dale’s Black Eye Palsy is a neurological disorder of certain nerves of the face, located in the orbit.
  Similar to Bell’s palsy which disrupts an output cranial nerve, Dale’s Black Eye palsy disrupts an input cranial nerve.  With Bell’s palsy, the loss of motor function makes diagnosis easy.  However, Dale’s Black Eye palsy is a loss of input signals, less understood and difficult to recognize.  Both disorders disrupt part of the same autonomic nerve.
  These nerves, the Infraorbital, the Zygomatic and the Greater Petrosal nerves (V2+) become entrapped in the orbit floor.  This entrapment leads to nerve compression.  The nerve compression reduces the nerve signal.  The weak signal results in palsy of the terminal systems.
  Symptoms occur when the nerves undergo nerve friction, intermittent and/or constant nerve compressions.  Initially, the friction may only be transient, resulting in symptom free periods.
  Orbit floor movement produces intermittent nerve compressions, proportional to the orbital floor stress.  Whereas, significant entrapment, infection, inflammation, cold, or rest produce longer constant compression.
  Strong sudden compression causes significant stimulation, and significant distress suddenly, like a ‘funny bone’.  Soft, constant compression is like a leg ‘falling asleep’.  Similarly, after these compressions, some recovery time is necessary before normal function returns, although longer.
  In most patients, Dale’s Black Eye Palsy is progressive, as the bones age.


  Allow me to give some background to my idea.
  We are just regular people, who experience cluster headaches.  At times we are fine.  Sometimes we suffer debilitating nerve pain and dysfunction.  Then we are fine again.
  I was embarrassed and frustrated that mostly I was fine.

  I got to thinking.  That sort of pattern reminded me of when I had a pinched nerve in my back.  I would be fine, then all of a sudden, pain and dysfunction; I couldn’t move.  Sometime later the pain would subside and function would return.  I could move around again.
  About this time, my brother in law John suggested I go see a chiropractor.  I thought his concern was nice, but crazy.  I wasn’t going to waste any of my money on that.
  Well, I had another attack (of course).  Nothing was helping.  I remembered what John had said.  I tried to imagine how a skull might be manipulated and started pressing, bending, and twisting at my head, while keeping my head and neck still.
  Low and behold, I found that certain grips could increase my pain, and other grip positions would reduce my pain.  I kept experimenting with successive attacks and found specific areas to press or pull to help reduce my pain.
  It tuned out that these beneficial maneuvers all act to open my bad orbit.
  Again I was reminded of back pain.  If I moved ‘wrong’, I would get a pinch in my back.
  It sure seemed similar.  But how could that be, which nerve?

  In general, our problem affects the same areas on each of us, such as: specific skin on the face, sinus issues, tears, etc..  Which nerves supply those systems?
  The skin and sinus are easy.  They are innervated by the Infraorbital and Zygomatic nerves, branches of the Maxillary nerve, a branch of the Trigeminal nerve.
  But what about the tears?
  The lacrimal gland is innervated by two nerves, the lacrimal nerve of V1 and the somatic Greater Petrosal nerve, also referred to as the ‘lacrimal feedback loop’.
  I had to think long on this problem.  Finally I found an answer that matches my dysfunction.
  When I cut an onion, both my eyes will tear.  I consider this to indicate the Trigeminal (lacrimal V1) nerve is functioning properly, protecting both my eyes from external insult.
  However, when I have trouble, I can only cry emotional tears out my good eye.  Emotions are part of the autonomic system.  That’s the lacrimal feedback loop.  A lack of nerve signal might cause this.

  Okay, I had these three nerves identified.  Next, I followed these three in toward the brain.  They first all meet on the orbit floor, before exiting the orbit out the inferior fissure.
  I’ve had imaging done.  That is the same spot that shows irregularity on my images.
  Ding, ding, ding, bells went off in my head.
  Might we all, who suffer, have an extra tight spot in that location?
  I'm just a regular guy.  I’m sure most of you feel the same way when you’re symptom free.
  Those nerves supply necessary input and output information.  Our dysfunction arises when the nerves are critically squeezed, kind of like a hose, less signal will flow, disrupting the end systems relying on these nerves.
  I know this sounds a little simplistic.  Sometimes the simple answer is the best answer.
  Do cluster headache symptoms result from a yet unrecognized nerve pinch point?  Is it similar to pinch points in the back, or carpal tunnel syndrome?  My experience is yes.
  I have been able to use this postulate to answer and explain all my questions about this disorder.  I look forward to helping you have a better understanding of this situation.

I got your black eye palsey right here in my right fist.

.

  Some have asked, ‘How do you know you have a pinched nerve in your face’?  It’s been my life.  This may help explain how I know.

  What is neurology all about?  At its base, it studies whether your nerves are patent, fine or not.
  What are our choices?  The nerve could be healthy, the nerves could be damaged, the nerve could have grown a neuroma (a nerve ball), there might be a chemical imbalance, the nerve is pinched, or, or what is the other choice?  That’s pretty much it, fine, damaged, nerve ball, chemical imbalance, or pinch.  Let’s compare our symptoms to these choices.

  I suffer cluster headaches, a neurological condition.  My nerves are troubled. 
  Damaged nerves tend to work consistently bad, with about the same amount of dysfunction.  Sometimes I am fine and without dysfunction.  My nerves must be fine at times.  This rules out damage.
  A neuroma, nerve ball, is like a little funny bone where ever it grows.  I have been evaluated for neuroma and found clear and free.
  Chemical imbalance?  The chemical disorders I think of tend to have a systemic effect, lots of the body is involved.  It seems unlikely that an imbalance would only affect one spot, on one side of the body.  Furthermore, what chemical imbalance changes as I move my head?  This is different from my symptoms.
  So, that only leaves pinch.  My symptoms have a pattern similar to when I had a pinch in my back.
  That’s part of how I know I have a pinched nerve in my face.

  A pinched nerve, so what?  Let’s see, this particular nerve is very primal.  It’s the largest in the body.  It is two and a half times more brain input, than the entire spinal cord.  It alone is more than half the input to our brains.
  Our brains really listen to it.
  Oh, remember we also have a pinched autonomic nerve.  Loss of this nerve signal creates its own havoc. 

Take it easy on that noggin.



These are some  of my triggers:
  -Sneezing and breathing
  -Walking, motor vehicle transport, especially on concrete
  -Head position, especially in motion
  -Sound: Talking, singing, etc., noise, vibration
  -Pressing the head to close the affected orbit
  Heat and cold will affect these triggers.

I’ve had a lot of questions about breathing as a trigger.  Here’s my take on it.
  We all at times get that unusual stuffiness.  I consider nasal stuffiness to occur between open and plugged.
  This stuffiness dramatically raises the nasal backpressure.  Forcing nasal breathing at these times will affect the Maxillary sinus and then the orbit floor.
  The orbit floor moves very little.  It’s a matter of summation.  Each little flex, squeeze, or vibration just adds a small amount of nerve distress.  The four types of stressors each add their little bits as you go about your day.  Once enough of these small assaults have reached a critical level, the next one, of any type, will cause revolt.  Now, how can you ever tell?  By this time some swelling has caused numbness.  It’s an input nerve needed for feedback.  No nerve signal is our problem.
  So, yes, I say breathing can be a trigger.  Given that:  You have stuffiness, you force nasal breathing, and your summation has reached a critical level.
  If you are having an attack, especially with stuffiness, breathe thru your mouth.  During an attack try to eliminate all four sources of orbit stress.  Mouth breathing and reducing respiration with O2 will both help with one form.
  When you draw a big fast breath in your nose, you can hear it.  This indicates increased nasal backpressure.  Avoid it.

lifer wrote on Jan 6^th, 2017 at 11:33am:


Bullshit.

       Potter

lifer wrote on Jan 6^th, 2017 at 4:01pm:


A wonky hypothalamus

         Potter

HEY...WOW!...I believe in "gate theory" too...so.... pull yur head out...FIND the gate...and
don't let it hit you on the ass on the way out...we'll have to repaint!

Elvis may be dead (?)...but even he doesn't give a damn if you're lonesome
tonight...neither do we....EITHER website..................

Best?........naaaaaaaaah.....

Jon

lifer wrote on Jan 6^th, 2017 at 9:08pm:


They have done a lot more than just guessed at a link between CH and the hypothalamus.

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

This describes research done using functional MRI scans of patients with CH attacks which show a clear link between hypothalamus activity and the CH.

lifer wrote on Jan 6^th, 2017 at 9:08pm:


However not all CH attacks occur during sleep and whilst many people have alarm clock CHs, not everyone does.

.

  Good, let's bring this up.  My motives.  I would like to help.
  I have suffered more than 40 years with this beast.  I am glad, but also a little ashamed it took so long, to have finally found my triggers.  I was having multiple attacks a day, knocking me down completely.
  I feel so blessed to be able to help myself now.  By managing and maintaining my physical actions, I can prevent and/or stop attacks.
  Now, unless I must engage in trigger type activity,  I am free of attacks.  It has changed my life.  My motive is to help all of you have that same experience.  My palsy still gives me some pain and dysfunction, but the attacks are gone.

  I am well aware that what I am proposing is revolutionary.  Sometimes that happens.  Thank you for exploring this with me.
  I’m sorry if I have made any of you uncomfortable.  If my idea is too far out there for you, I understand.
  What I would like is a discussion regarding the merits and shortcomings of my postulate.  Could this be possible?  Does anyone else find it fits their symptoms?  My made up title is just a way to identify this particular idea, which fits my symptoms.
  Whether my idea pans out or not, we will still be haunted.  We will still have cluster headaches, whether it’s primary or secondary.
  Even if what I claim is found true, no one will help.  There is no approved surgery for my suspected cause.  No one is trained to perform it.  You’re likely to be made worse in an attempt to fix it.  I find no comfort in that.  It’s just our situation.

  I have found ways to comfort my nerves, reduce my pain, reduce my dysfunction, and reduce my attacks.  This may not be your thing.  That’s okay.  I’m totally convinced it’s mine.
  I moved forward when I stopped focusing on the pain, and started paying attention to my dysfunction.  The pain is unreliable.  It can be too much and overwhelm you, or go numb and trick you.  The dysfunction is a lot easier to discern and provides a reliable indication of nerve distress.


  To clear up any confusion, I suggest that you stay away from a chiropractor for this condition.  However, I have noticed we tend to hold our heads.  Head holding is good, especially in the right spots.

  I realize I use lots of medical terms about our medical condition.  It’s just how I think about it.  If my words are giving any of you trouble, please have me try explaining myself a different way.  I am trying my best to clearly express this idea.

.

Skin / Infraorbital, and Zygomatic Nerves
  The affected skin is innervated by the Maxillary nerve.  Often the superior path of the Zygomatic nerve is mistaken for Ophthalmic nerve involvement.  Only V2+ compression is necessary for Dale’s Black Eye Palsy.

  Changing subjects, I’ve read back over my writing.  I use the terms compression, squeeze, pinch, and attack to try and make my point more clear.  Most of the time, we are noticing nerve irritation and inflammation.
  An inflamed nerve can swell.  The offending pathway stays the same size.  Relatively, the hole just got smaller, causing distress.  Treatment for inflammation is good.
  I appreciate the help and concern I’ve received from other members regarding inflammation treatment.

.

  Good, you’re still with me.  There is lots more to discuss.  This one is a major problem for us, and one that is near and dear to me.

Temperature

  How about that temperature?  I’ve had trouble finding others to talk to about temperature.  Outsiders just don’t get our unusual, inappropriate, or uncomfortable sense of temperature.

  I’ve got some thoughts about temperature.  If you have questioned my sanity already, be warned.
  I’ll be making assumptions and inferences that are different.  I’m going to coin new phrases; current outsider vocabulary fails me.
  This is a work in progress.  I promise to make mistakes.  I also promise to express my explanation of our disorder the best I can.

  Have any of you noticed this?  When out for a hike, you happen to cross a small creek.  Your feet feel the cold water.  The local skin contracts.  The local blood vessels may initially shrink, then dilate.  The rest of you doesn’t really care.
  A different particular part of the body is used for ‘core’ temperature control.


  You all know by now that I consider this a nerve problem, which reduces our nerve signals.  How can this be applied to temperature?

  Let’s start with normal.  Here it goes, outsiders will understand this part.
  Let’s compare our bodies to our houses.  Our bodies and our houses both have a thermostat with three settings, Off, AC, and Heat.  The house uses two wires, the body uses two nerves.  The house thermostat sends its signal to the HVAC system.  The body’s thermostat sends its signal to the hypothalamus.
  Your body senses temperature with two types of nerves.  The first type transmits a cold PAIN signal, and the second type transmits a warm signal.  These two nerves go to a little spot that acts like a thermostat, the Trigeminal Spinal Nucleus (TSN).
  When the two nerve signals are about the same strength, the thermostat stays in the Off position.  Along the same line, a critically larger cold PAIN signal will switch the thermostat to Heat.  A critically larger warm signal will switch on the AC.
  As we move through our day, these two nerves bounce us back and forth; helping us maintain an appropriate ‘core’ temperature and a feeling of comfort.
  This is how it should work.


  This next part is outside of outsiders’ frame of reference.  That’s okay, it’s just how their wired.
  If you’re going to continue, remember, I warned you.

  Our thermostat can have six positions: Off, AC, Heat, Only AC, Only Heat, and Only Off.
  We share the first three with everyone else, when everything is working.
  However, our wires sometimes lose contact and make an open circuit; or, our nerves are squeezed enough to block the signal.
  So what happens when the wires go out?  The thermostat gets sticky.
  A loss of cold PAIN signal will stick it on AC.
  A loss of the warm signal will stick it on Heat.
  A loss of both will.....  A loss of both will separate us from the others.  I used to call it ‘lost temperature’ when I was younger.
  How about when it is stuck Off?  The loss of both nerve signals fails to stimulate the thermostat (TSN) to output a signal.  Your AC and Heat are both stuck off.  You must manage your own heating and cooling.
  But wait, both nerves are numb.  How are you going to tell if you need to warm, or you need to cool yourself?  You can’t.
  Realize, temperature is the foundation of proper body function.  Life happens on a backdrop of temperature.  You gotta’ do something.  In that moment, I have no advice yet.
  I have found it best to avoid extreme temperatures during these times.  Temperature dysfunction is worse than pain for me; I feel a primal sense of discomfort.
  Do what you can to sooth your nerve, let it rest every so often.  Maintain your nerve health as a preventative.

  Notice this feeds to the Hypothalamus?  This is another cause of confusion about the hypothalamus.  Its working fine.  During Trigeminal temperature signal palsy, it receives a bad signal or no signal.

  We’re gonna’ keep going.

  Here’s where that inference happens.  We have temperature control dysfunction.  Therefore, one of our pinched nerves is the location responsible for ‘core’ temperature.  See it?
  If I were building us, I would use the Infraorbital nerve.  It can simultaneously sense the ambient air temperature, radiant temperature, and body temperature.
  I always argue that ‘core’ temperature is in the brain.  The body is just thermal mass.

  Temperature control is a forward feed system.  It is my experience that it feeds forward about three hours.  What your face feels now will spill out the body in three hours.  I notice it as a sense of ‘temperature delay’.  It seems focused more on the opposite good side of my body, contralaterally.
  This is the scary part about ‘lost temperature’.  You are unable to sense it initially.  You are still running off the thermostat setting from three hours ago.  Three hours later, ‘lost temperature’ spills out the body.

  Think back to your thermal environment three hours earlier.  Focus on your present thermal environment.  Stabilize your temperature, avoid temperature spikes, would you want to have that temperature later?  This is really hard for me to say.  If it makes sense to you, great.  If it doesn’t, don’t worry, it’s very primal.
  When you’re stuck on freezing or stuck on hot, it’s easier to learn.  It’s a no brainer.  If you’re hot, cool your face.  If you’re cold, warm your face.  Just remember to stop at the temperature you would like to have in three hours.

  This is my experience with temperature maintenance while having dysfunction.  This is just one symptom of Trigeminal nerve compression.
  The attack is the initial nerve revolt.  You got hit on the funny bone.  It’s gonna’ really hurt, then tingle for a while, numbness.  I’m trying to help you manage the dysfunctions suffered during numbness.  Continued compression creates continued numbness.  You may have continuous dysfunction.  Let’s find ways to treat our dysfunction.

  I really want to have an appropriate temperature, much more so than being pain free.  Notice all the PAIN?  Temperature is sensed by cold PAIN nerves and warm nerves.  I need PAIN to regulate my temperature.

  I discourage aggressive use of pain killers and drugs that diminish nerve activity.  We have a loss of signal.  Knocking down the weak nerve signals will bring more dysfunction.  I do advocate the use of certain nerve stimulating drugs during times of dysfunction.

  A caution on ice.  Icing is good in small doses.  It should be used in short ‘hugs’, to avoid numbness.  Ice used until numbness is bad.  We need that nerve signal.

  Want to know why some of us are hotties and others cold all the time?  Why do we switch between hot and cold?  I have the same answer as to why at times it may be my eye, or skin on another person.
  The nerve is pinched unevenly.  Each of us squeeze it our own way.  At times of nerve friction, this distribution may change.  This may lead to a change of which particular nerves are affected.  Once in a while it will slip, and be pinched in a different spot.

  Wow, what a mouthful.  Can you tell I’ve been dying to talk with others who share temperature dysfunction?  Does any of it sound familiar?
  Where would you like to go next?


.

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

        Here ya go, try your schtick there.

              Potter

.

Risk Factors
  Individuals with risk taking behavior engage in activities which put them at a greater chance of head trauma.  Any head trauma resulting in injury to the orbit floor may cause this palsy, commonly occurring during youth.  Injuries resulting from a black eye are suspect, as well as, infants dropped upside down on the front of the head.  Typically unilateral, rarely, a severe or repeated trauma may result in bilateral palsy.
  Age 40+.  With age, comes the solidifying of the skull.  This hardens and ‘roughens’ the small orbit floor path.
  Specific congenital defects, affecting this pathway, may also cause or predispose this palsy.



Internal Nasal Valve / Infraorbital
  The internal nasal valve is located just inside the nose.  In mammals the resting state of the valve is closed.  It requires a signal to dilate.  In humans, the infraorbital nerve supplies a constant background signal for dilation.  Breathing thru the nose will induce an additional signal that opens the valve further.  The diving reflex may also interrupt this nerve signal.
  Constriction of the valve also disrupts the normal nasal air flow resistance, inducing a feedback loop similar to nasal cycle palsy.


Sinus / Infraorbital
  It just has to be a sinus issue!  Well, kind of.  The Infraorbital nerve supplies the sinus.  When this part of the nerve suffers compression, the cilia and mucus cells that clear and clean the sinus are weak or paralyzed.  Furthermore, the mucus cell dysfunction limits their ability to activate the limbic system.   As insulting contamination accumulates and increases, so does infection.  This is often accompanied by nasal valve collapse and tonsil palsy.  The collapsed valve reduces the ventilation of fresh air and blocks the discharge of liquid drainage, thus increasing the chance of a sinus infection even further.  Tonsil palsy may occur, slowing infection clearing.  Once an infections is established, total recovery is difficult.  The infection, inflammation, and sinus swelling increase the nerve compression and sinus palsy.  See ‘Nasal Cycle’.




Thankfully, just the lucky few of us, who have entrapment of those mentioned nerves, notice this.

Kinda like only people with a pinched nerve in their back notice it.  When its pinched, major pain.  When it gets loose, no problem.


  Wow!  Thanks for the link Feisty.  I am surprised to read this.  This describes how we at times have a one hour heart rate rhythm delay.  It goes on to note a lack of pulse rate variability.  I at times have chest pain during and after attacks.  Often, my pulse tends to tick about the same.
  Is this something like when I feel a sense of ‘temperature delay’?  That sounds similar.
  How do we manage our heart rate rhythm an hour in the future?


Clin Auton Res. 1993 Oct;3(5):291-8.
Imbalance of heart rate regulation in cluster headache as based on continuous 24-h recordings.
Micieli G1, Cavallini A, Bosone D, Tassorelli C, Barzizza F, Rossi F, Nappi G.
Author information
Abstract
An altered autonomic balance is considered to be a pathogenetic factor in cluster headache syndrome, although there is varying data on sympathetic and/or parasympathetic activation during attacks and/or attack-free intervals. The aim of the present study was to evaluate the day/night pattern of heart rate during the active and remission phases of cluster headache. In addition, the relationship between heart rate changes and the site of pain was investigated to determine if an autonomic imbalance was related to the lateralization of pain. Thirty-nine patients (34 with primary episodic cluster headache and five with primary chronic cluster headache and 30 healthy controls underwent 24-h Holter ECG recording. Nine cluster headache patients were monitored during both phases of the disease. The data obtained confirmed the existence of a disordered chrono-organization in cluster headache (phase-shift of approximately 1 h of heart rate rhythm during the cluster period) together with a low heart rate variability and a higher occurrence of arrhythmias in cluster headache patients with right-sided pain. Differences were also observed in the cluster headache patients when headache free, excluding the pain itself as a reason for the abnormality. The chronobiological data point out a transient rhythmic dysfunction, while heart rate variability changes, mostly related either to the phase of the disease or to the site of pain, probably reflects a central, site-related, dysfunction of the autonomic nervous system in cluster headache.



---------------------------------------------------


  I apologize for the vulgarity you had to wade thru.
  The rest is pretty sparse.  You might search my posts.
  I still like to follow this anyways, so please, feel free to comment.

  Thank you for your time and consideration.  I hope you all the best. 

jon019 wrote on Jan 8^th, 2017 at 8:46pm:

  For the win.

                Potter