Trigeminal neuralgia may be managed by pain modifiers [POSED BY MODEL/GETTY]The cells of the upper airway, the nose, the sinuses and the throat all produce small amounts of mucus to keep them moist.
Without it your nose and throat would feel dry and uncomfortable. It can also help to protect against infection but if produced in large quantities it can collect in the back of the throat, particularly at night.
The most common reason for this is inflammation due to allergy and this can usually be tackled by using a steroid nasal spray.
Several types are available but the stronger ones (such as fluticasone) generally work much better than the weaker ones which contain beclomethasone.
None of them works straightaway and they must be used every day for at least two weeks before they take effect. So please be patient.
It is also important to use nasal sprays properly. Don’t tip your head back as this just directs the spray down your throat where it won’t help. Instead sit upright and direct the spray towards the outside lining of each nostril.
Excess phlegm can also be linked to acid reflux from the stomach which can then irritate the throat. This is more likely to be the cause if you have symptoms of indigestion or heartburn. If so medication that reduces acid production can help and this is available from your GP.
Q I developed the condition trigeminal neuralgia about four months ago, it began with severe pains in my forehead and has developed into constant pains in my forehead and over the top of my head when I eat, drink or move.
I am now taking Tegretol, an anti-epileptic medication which is keeping the pain at bay, but I would appreciate advice on how to cope.
A Trigeminal neuralgia is a condition that causes severe pain in the face. The trigeminal nerve is responsible for carrying sensations of touch and pain from face to brain and also controls the muscles used in chewing and the production of saliva and tears.
The pain of trigeminal neuralgia is thought to be caused by pressure on the nerve from a blood vessel as it leaves the brain.
Why this happens is not known but is more likely in people over 50 and in women more than men.
The pains are severe and often described as stabbing or like an electric shock and usually only affect one side of the face.
The second and third branches of the nerve are affected more than the first so you are unusual in having pain in your forehead. The pain often starts for no reason but may be triggered by touching your face, by eating or cleaning your teeth. The diagnosis is usually made on the symptoms alone and tests are not helpful.
The pain can usually be managed by taking carbamazepine which dampens down the pain message.
If this does not help then similar pain-modifying agents can be used, such as gabapentin or lamotrigine.
It is normal with all of these to start with a small dose which is gradually increased. Once the pain has gone the drug should be continued for about a month then gradually reduced and stopped.
Most people stay pain free for months but there is a chance it will recur in which case the medication will need to restart. For those with severe intractable pain surgical treatment is an option. However this can carry the risk of losing sensation in the face or of deafness.
You can get more information from the Trigeminal Neuralgia Association by calling 01883 370214 begin_of_the_skype_highlighting 
01883 370214 FREE end_of_the_skype_highlighting or visiting tna.org.uk.
01883 370214 FREE end_of_the_skype_highlighting or visiting tna.org.uk.If you have a health question for Dr Rosemary please write to her in confidence at The Northern & Shell Building, 10 Lower Thames Street, London EC3R 6EN or email health@express.co.uk.
Dr Rosemary’s reply will appear in this column. She regrets that she cannot enter into personal correspondence and cannot reply to everyone. Find out more about Dr Rosemary at drrosemaryleonard.co.uk
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