Do I sound like I have ATN? Need help :(

Hello guys, I am only 18 this year and am very frustrated right now due to symptoms on my face. I will tell you my story and how it all began. I am not a native speaker so please excuse me if I made any mistakes. Sorry if I make it too lengthy, but I really dont know who to talk to anymore :(. Please I really need some guidance/suggestions.

It all started two months ago. At first I was having dry eyes and during that period I noticed some weird symptoms on my face. They were such as light twitching of my cheek, teeth clench itself, ear twitches itself involuntarily. They were on my right side of face at first. Once in awhile, they shift to the left. The combination of these symptoms will make me feel like my face was being punched on one side. It feels kind of stiff&numb. They stayed on my right side for quite some time but usually come and go. By the way, my dry eyes are healed after some time.

Fast forward to today, my symptoms have changed/developed. Half of my face ache, but it doesn't stay forever. It will shift to the other side, back and forth. Aside of aching, my face feels kinda 'swollen' . I mean when a body part is swollen you feel kind of 'stiff & numb' right? I am able to control my face just that I feel like I am moving a stiff cheek. Besides, my eye on the affected side will get the same sensation too. The sensation is obvious when I blink my eyes. Blinking is a fluid and smooth motion right, but I am very aware when I blink because it just feels kind of stiff.

My teeth hurt and feel tight. Sometimes, the teeth in the affected side will want to clench themselves. The symptoms dont always shift like a mirror image, sometimes it's just the eye symptom that shift or the teeth. Anyway, I do have tender spots mostly on the left side of my face. They are located at the temple, near my ear(near jaw hinge), cheek (in-line with my ear) and near the jaw bone. Pressing these spots are pain, but will kind of relieve the symptoms on that side temporarily. For eg, if I massage these spots, the eye on that side will kinda 'release' the stiffness and pass it to my other eye.

Sorry that I am unable to explain my symptoms very clearly. I have seen several eye docs, a few ENTs, a TMJ specialist(chiropractor) and a dentist. Thus, some possibilities have been ruled out. I did a dental xray and it shows that my teeth are fine and very slight problem in left side of my jaw. The current doctor I am seeing now is a neuro-acupunture. I just started her medication now and the pain has become minimal but the 'stiffness&numbness' still persist. I just feel like being punched on one side of the face without any pain now and it changes side.

I dont have any triggers as far as I am concern. I find that wearing glasses will kinda exacerbate my symptoms but not really triggering them. I've seen this discussion in the ATN section too. I do clench/grind my teeth at night sometimes. Do my symptoms sound like 'early signs' of ATN? Is there such thing? Or could it be something else?

If I may, I'll add a different perspective based on nearly 20 years of talking with thousands of facial pain patients.

The stiffness and numbness that you report are common in a symptom called "parasthesia", which often occurs as a precursor to more developed neuropathic pain. The twitching that you report might be a mild case of what is called "hemifacial spasm", caused by compression of the 7th cranial nerve by a blood vessel. The sensitive zones you describe are also common with hemifacial spasm and nerve compressions.

Although tempro-mandibular joint disorder is a possibility, I would not evaluate it as likely. TMJ is often over-diagnosed by dentists who have inadequate training in neurology. It is also a very imprecise diagnosis that can be and often is "stretched" to cover a wide range of pain symptoms and patterns throughout the face and down into the neck and shoulders.

Accupuncture does appear to help some people, some of the time. But it isn't uniformly predictable or reliable for facial pain or parasthesia. Sometimes it works, and sometimes not. Some patients report having bad breakthrough pain reactions when needles are placed in or near "trigger" zones such as you describe.

I think you need to be worked up by a neurologist who regularly treats face pain patients. We have a list of hundreds of doctors and hospitals where members here have had a good outcome. See our "Find A Doctor" page or tell me where you live and I'll see if I can find somebody for you.

Feel free to come back with followup questions.


Red Lawhern, Ph.D.

Resident Research Analyst and Moderator, LWTN