Progress Note: The Case of Migraines Triggered by Trigeminal Neuralgia

What happened after I wrote about Gretchen 3/12/23

During my 15 years of blogging I have had more than a few comments expressing some frustration that I leave the reader hanging. Sometimes, I admit, I do that for effect, but more often I write about fresh observations before the “case” is fully resolved.

Eight days ago I wrote about Gretchen, whose migraines came back after a couple of decades and seemed to be triggered by a trigeminal neuralgia that started after a facial skin lesion removal. I gave her Imitrex to stop the headaches and started her on Tegretol (carbamazepine) a few days later for the trigeminal neuralgia.

Today I got a call that the facial pain seemed to be gone but would recur with straining or bending forward (remember her sinuses were clear on her MRI). So, I believe I am on the right track with my trigeminal neuralgia diagnosis. I asked her to increase the carbamazepine from 100 mg twice daily to 200 mg each dose and let me know how that worked.

My blog posts were perhaps a little literary sometimes, but here on Substack, where I have a “Quick Takes” category , I will post updates on cases and things I have written about - for fellow clinicians and other readers with an interest in the diagnostic and therapeutic process.