DR ELLIE CANNON: What could be causing a constant ache near my cheek at night?

For the past five years, I have occasionally suffered from a dull, persistent pain around my right cheekbone that wakes me up at night. But one evening last week the pain also spread to the side of my right eye. I also had wavy lines in my vision. Do I have to worry?

Facial pain is distressing because it is impossible to ignore and often difficult to diagnose.

One of the worst pain syndromes, trigeminal neuralgia, affects the face and patients say it feels like they are receiving constant electric shocks.

The condition, which is often caused by pressure on the trigeminal nerve in the head, can be triggered by simply touching the face and is debilitating.

Fortunately, this doesn’t sound like a case of trigeminal neuralgia. However, there are many more reasons why you experience this pain.

Facial pain can be caused by dental problems, sinus problems, certain types of migraines or headaches, as well as problems in the jaw. All these options can be explored during an assessment with a GP and possibly a dentist.

Likewise, wavy lines in the eye, which we call floaters, should always be assessed by an optician. Floaters are normally harmless and caused by minor changes in the eye jelly, but if they occur suddenly it can sometimes be a symptom of retinal detachment, a serious condition that if left untreated can lead to vision loss.

Whatever the cause of your pain, it makes sense that it gets worse at night. This is because when we lie down, we put pressure on the head and neck. This can worsen a damaged nerve or an ongoing sinus problem.

A problem that has lasted for five years and seems to be getting worse certainly warrants a consultation with a doctor.

I have been taking the blood thinner warfarin for 13 years to treat atrial fibrillation. Recently, during a hospital consultation for an unrelated problem, the doctor suggested that I should not bother with it as there were better medications available to control the condition. Should I change my medication?

Atrial fibrillation (AF) is a condition in which the heart rhythm is abnormal.

Instead of beating regularly in the usual pattern, the heart beats irregularly and can also beat very quickly. This can lead to palpitations, chest pain and dizziness. But it can also cause blood clots to form in the heart and elsewhere, which can lead to a stroke.

Unfortunately, a stroke in someone with atrial fibrillation is usually more serious than other strokes. For this reason, people with atrial fibrillation are advised to take medications that prevent the formation of clots – this reduces the risk of stroke by about two-thirds.

One such drug is warfarin, which has been used for 70 years. However, the NHS now recommends a drug called a direct oral anticoagulant or DOAC which would usually be apixaban, edoxaban or rivaroxaban. This should be taken with other medications that can slow a fast heart rate or help improve heart rhythm.

Research shows that DOACs are just as effective at preventing clots as warfarin, but have fewer side effects.

If someone has been diagnosed with AF and is already taking warfarin, he/she can continue, but it is better to switch to the newer type of medication.

I use an inhaler for asthma. Sometimes I start coughing and my lungs get completely congested. I have trouble breathing, so much so that it is impossible to use my inhaler. Eventually my breathing returns to normal, but it is very scary.

A GP or practice pharmacist can discuss the options surrounding warfarin and the newer medications and clearly explain which is most suitable.

I use an inhaler for asthma. Sometimes I start coughing and my lungs get completely congested. I have trouble breathing, so much so that it is impossible to use my inhaler. Eventually my breathing returns to normal, but it is very scary. This happens approximately once every fourteen days. What can I do?

ANYONE who has asthma, even at the milder end of the spectrum, should discuss their condition regularly with their GP or practice nurse. Having these symptoms every two weeks would indicate that the asthma is not being treated properly.

There may even be another lung condition involved, such as chronic obstructive pulmonary disease – also known as COPD.

Sometimes we see that patients have been labeled as having asthma since childhood or a historical episode, but they have not been properly assessed.

Nowadays there are tests for asthma that can be performed in a doctor’s office. This can be useful to confirm asthma or point to another diagnosis. Anyone with asthma or lung disease who uses inhalers should make sure they use them correctly. People are often taught incorrectly at first and never learn how to inhale the medication properly.

A pharmacist or practice nurse can advise you on this and there are also excellent training videos online.