Cryptogenic Pain, Chronic Pain, Trigeminal Neuralgia, Headache, Migraine

Cryptogenic is a term that’s used to describe an origin that’s uncertain. If you don’t know what’s happening or what’s causing a particular symptom, it’s cryptogenic. We may call it ideopathic, which is really rather disingenuous. Ideopathic this, ideopathic that. It simply means that we don’t know why it’s there. Well, the fact of the matter is, or that it has no cause. Everything has a cause.

Everything in life, whether it’s in medicine, the economy, sports, it doesn’t really matter. Everything has a cause, so what’s the cause? And if you don’t know the cause, it’s “cryptogenic.”

It may be medical or it may not be. Not everything is diagnosable by a medical doc. An individual that makes the diagnosis properly, or improperly. I have my preferences. My preference is on the medical side, but it may be a physical therapist. It may be a chiropractor. It might be a teacher. It doesn’t really matter

But the fact of the matter is it really doesn’t matter who makes the diagnosis as long as it’s proper. I was going to talk about headache and facial pain.

What’s migraine anyway? “Well, is it a severe headache?” No, it’s not. Migraine is a particular type of vascular headache that may not have any pain at all. You can have migraine, and have no pain. You can have just nausea.

You can have ophthalmic migraine where you can lose your vision and have no pain at all. It’s not a matter of severe pain meaning migraine or migraine meaning severe headache, but it’s all cryptogenic until you refine the diagnosis and get things pretty close to where they need to be.

The trigeminal nerve is actually a very interesting structure that innervates the head, the face and the neck.

And it doesn’t innervate the muscles of the face, so it doesn’t cause any weakness, and this is very important. But it can cause some terrible, terrible pain when it gets bad and people present in a very typical way, they’ll be told they have tic douloureux, which is a type of lancinating pain that innervates, or that involves certain distributions of the face. Well, when they present that way, any idiot can make the diagnosis, but most patients with trigeminal neuralgia will have much softer findings. They may have pain in the temple. They may have pain behind the eye that comes and goes.

They may have pain in the teeth. They may have their teeth removed, thinking that, that that’s the cause of the pain. I have people that come in that have had half the teeth in their face removed because of trigeminal neuralgia caused by a branch behind the jaw, right in front of the ear. So you can make the diagnosis easily enough with your fingertips. You confirm the diagnosis with the transdermal medications and you’ll know it within 60 seconds. It doesn’t take very long at all.

So, oftentimes we’re in pain but we don’t know where it’s coming from.

Everybody knows from their Boy Scout, Girl Scout, Cub Scout training, that you can have a heart attack and where do you feel it? Numbness down the arm and into the jaw. That’s where the, the 6-year old kid’s supposed to grab the old person and tell them what to do. Never works, but it, it looks good to get a badge, right? The brain doesn’t always know where pain is coming from. People come in and they have pain, pain in the front of the knee.

Well, why the front of the knee? Because the front of the knee bumps into things, so the brain actually learns how to map that area out. You develop a tendinitis behind the knee. Your brain doesn’t know where this is coming from because most people don’t interact with the world with the back of their legs. So what happens is they experience pain in the front, the pathology’s in the back, and then they go in and get surgeries on the knee that don’t help– its’ really sad, but it happens all the time.

About David S Klein, MD 149 Articles
David S. Klein, MD, FACA, FACPM was born in Washington, DC, and was raised in Chevy Chase, Maryland. He completed his undergraduate education at the University of Maryland with degrees in Chemistry and Psychology. Medical School was completed at the University of Maryland at Baltimore, followed by Internship in General Surgery at the University of North Carolina and Residency in Anesthesiology at the Duke University, Durham, North Carolina. Dr Klein has been practicing medicine since 1983, concentrating in Pain Medicine, Minimally Invasive Medicine and Surgery, and Neuroendocrinology. Earning Board Certification in Anesthesiology, Dr. Klein was elected Fellow in the American College of Anesthesiology, and he was elected Fellow in the American College of Pain Medicine. He is currently an adjunct Associate Professor at the University of Central Florida, School of Medicine. He has focused his private practice on treating patients with hormone imbalance issues, nutritional deficiency related medical problems as well as pain related issues and impairment. With a highly-complex, CLIA licensed laboratory in-house, he has been able to provide rapid-turn around analysis efficiently and cost-effectively. Lecturing extensively nationally as well as internationally, Dr. Klein has authored many articles on topics relating to pain, injury and nutritionally modulated illness. His radio show, “Pain Free Living,” received top ratings during the 6 years it was on the air. Currently practicing in Longwood, Florida, Dr. Klein practices entirely in the office setting.