Q: How would you recommend treating optical neuralgia? My daughter has suffered with pain around the top of her left eye for well over a year that never goes away. It is most upsetting and slowly tearing our family apart.
A: Facial neuralgias are a difficult group of disorders to treat. One type of medication that is sometimes useful is the sodium channel blockers, which presumably work on the more peripheral nerves, slowing the transmission of pain impulses back to the brain. Examples include carbamazepine and lamotrigine. Medications that work more centrally in the brain to inhibit pain transmission include baclofen, gabapentin and pregabalin. Tricyclic antidepressants can be helpful in combination with one of the other two classes of drugs.
Osteopathic approaches can be helpful, too, by reducing secondary muscle tension that can lead to a variety of head and neck pains. Alternative approaches such as acupuncture and training in self-hypnosis have also been shown to be effective. Many times a combination of medications and mind-body approaches turns out to be best for improving quality of life. Understanding and treating other family members who are stressed by the illness are also key to successful management.
Of course, before any therapy is undertaken, it is important to rule out underlying disorders that might be producing the type of pain around the eyes you described. Neurological consultation with appropriate imaging and blood work are central to treatment.
Doug Mann, MD, UNC Professor of Neurology, Chapel Hill, NC
