Horton's Cephalgia ( ... we need Dr. Bones )

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Posted by Chonas ( on February 20, 2000 at 20:56:08:

Geniculate Neuralgia/Cluster Headache (Horton's Cephalgia), Atypical Trigeminal Neuralgia, Bell's Palsy

Geniculate neuralgia and cluster headache are unusual syndromes which may be related to vascular compression of a small nerve known as the nervus intermedius. This small nerve travels between tthe seventh and eighth cranial nerves (the hearing and balance nerves and the nerve that moves the muscles of the face). Cluster headache is more common in men than in women involves severe migraine type headaches around the eye on one side of the head. It is usually accompanied by nasal congestion, tearing, redness in the eye and a drooping eye lid. Medical treatment should be tried first and there are a number of medications which are available. We have found good results with Sansert. In approximately 10% of patients suffering cluster headaches, these headaches become intractable and do not respond to medications occurring many times a day. There are two surgical treatments for this disorder, microvascular decompression and radiofrequency rhizotomy.

Geniculate neuralgia, which is also known as nervus intermedius neuralgia, results in severe deep ear pain. The pain is usually sharp in character and patients usually describe it as an "ice pick in the ear." However, it can be also described as a duller burning pain and can be accompanied by facial pain. Some medications can be effective in treating this such as Tegretol or Sansert. Operation is reserved for those patients who fail medical treatment either because of continued pain or undesirable side effects from the medicines. The operation consists of microvascular decompression and section of the nervus intermedius. Sectioning this small nerve carries minimal side effects.

Atypical TGN is described as a burning pain deep in the face. It is an extremely difficult problem to treat, either medically or surgically. Surgical treatment of atypical TGN by MVD is generally reserved for those who have some overlapping characteristics of typical TGN, ie. a sharp component of pain, pain triggered by touching the face or other inciting factors, or pain helped by Tegretol.

Bell's palsy is usually a self-limited facial paralysis, but in some can prolonged facial paralysis occurs. It has been our observation that relief of vascular compression upon the facial nerve can result in some recovery of facial function.

Results: Microvascular decompression for cluster headache is usually very effective with over 70% of patients experiencing relief in the immediate postoperative period. However, over time the recurrence rate is high but still approximately 30% of patients remain headache free with long term follow-up.

Geniculate neuralgia or deep ear pain carries a very high success rate similar to that seen with trigeminal neuralgia and hemifacial spasm. With long term follow-up over 70% of patients are pain free after microvascular decompression for this rare disorder.

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