Question: I have dull pain in my left jaw, from the back around to the middle of my front teeth, which also runs into my left ear and causes severe earaches. I have seen my dentist, an ear, nose, and throat doctor who x-rayed me, and then another dentist. No one can find anything wrong. I am taking Aleve sometimes three times a day. The pain will ease and then come back. Could this be from the Fosamax that I took for about 18 months?

Dr. Hibberd's Answer:

Since your exams all turned out to be normal, you probably have trigeminal neuralgia (TN), which isn’t found with dental and ENT exams. The pain that is a very rare complication of the osteoporosis medication Fosamax is rarely intermittent.

Trigeminal neuralgia (known as "tic doloureux" or “tic") is characterized by a lancing electric-like shooting pain that occurs along one of the 5th cranial nerves known as the trigeminal nerve. Facial trigger points and initiation of pain by movement (such as brushing teeth, chewing) are common. The diagnosis is clinical, and blood tests and imaging are not used to confirm its presence.

'"Tic" is believed to be caused by external compression of the trigeminal nerve from abnormal venous or arterial loops as the nerve enters the brain. Other conditions that may give similar symptoms include multiple sclerosis and other demyelinating disorders.

There is no cure, though recurrences, which usually respond to carbamazepine and other anticonvulsant medications, can be minimized. Gabapentin, Dilantin, baclofen, and amitryplyline are also used as alternative medication options. Rarely, ablation treatments that destroy nerve fibers are considered as a last resort to relieve intractable pain. Ablation can be performed by electrolytic treatment, balloon compression, chemical treatment, the gamma knife, or surgical resection.

You should arrange to see your primary care physician for initial treatment, and then if necessary, obtain your physician's referral to a neurologist for further treatment and consultation.

It is unfortunate your subspecialty consultations have not served you well. With undiagnosed health conditions, it is usually wise to involve your primary care physician (family doctor or internist) first. Remember that most conditions and injuries can be quickly and effectively treated by your family doctor without having to wait for subspecialty appointments. This way your care can often be initiated without delay, necessary referrals made, and premature specialty referral avoided.