Trigeminal Neuralgic‐Type Pain and Vascular‐Type Headache Due to Gustatory Stimulus

Abstract

We present a case of facial pain associated with sweet stimulus. An immediate, electric-like, short, unilateral pain was evoked by strong sweet gustatory stimulation. This was followed 6 to 8 hours later by a bilateral severe headache associated with bilateral tearing, rhinorrhea, periorbital swelling, flushing, and photophobia that lasted up to 2 days. The immediate pain that was experimentally induced with 2.5 grams of sucrose placed on the tongue could be abolished with carbamazepine. However, carbamazepine did not prevent the headache complex that appeared 6 to 8 hours later. Conversely, a trial with indomethacin abolished the late-onset headache, but not the immediate neuralgic-type pain. The independent nature of these pains suggests different pathophysiological mechanisms which are discussed.

Atypical triggers in trigeminal neuralgia: the role of A-delta sensory afferents in food and weather triggers

“…Two cases in our cohort reported that sweet food was a trigger, and sweet food has been reported in at least two other case reports in the literature [11,12]. Then, it was postulated to be due to the convergence of gustatory and trigeminal afferents in the brainstem.…”

“…Light touch and facial movements are well known stimuli, and studies have mapped a range of intraoral and extraoral trigger zones [6]. Anecdotally, other non-mechanical triggers, such as cold weather and certain foods, have been thought to provoke TN [7,8], although the literature has been largely limited to case reports and case series [9][10][11][12][13]. Given the increasingly important role that these triggers have on the pathogenesis and diagnosis of TN, our study attempted to characterize the frequency and nature of atypical triggers, specifically food and weather triggers, in patients with TN.…”

Treatment of Idiopathic Gustatory Rhinorrhea by Resection of the Posterior Nasal Nerve

“…Raphael et al (1989) first reported idiopathic gustatory rhinorrhea to possibly be caused by a congenital condition, however, no substantial evidence supporting this theory was ever reported. Certain foods contain chemicals that stimulate the afferent sensory nerves in the mucosa of the mouth and oropharynx by interacting with either chemical or irritant receptors or by eliciting the release of neuropeptides from the sensory nerves (Hercer et al 1998). However, the present case seems to show a different mechanism of hypersecretion from that reported by Raphael et al (1989).…”

Indomethacin Responsive Headaches: Exhaustive Systematic Review With Pooled Analysis and Critical Appraisal of 81 Published Clinical Studies

“…The pain could be abolished with carbamazepine acutely; however, carbamazepine did not prevent the headache complex that appeared 6–8 hours later. Conversely, a trial with IMC abolished the late‐onset headache, but not the immediate neuralgic‐type pain . Could this be a tic‐LASH syndrome?…”