137 Menstrual Synchrony of Burning Mouth Syndrome

Abstract

Study Objective: Burning mouth syndrome(BMS) is characterized by oral mucosal burning sensations, with normal clinical and laboratory results.Menstrual synchrony of migraines and epilepsy havebeen discussed; however, menstrual synchrony of BMShas not heretofore been described. METHOD(S): Case Study: A 29 year old right-handed femaleexhibited intermittent BMS symptoms, one month aftersuffering a left parietal infarction. She describes the painas a burningsensation, localized to the bilateral andanterior aspects of her tongue. It lasts for four days,starts three days prior to her menses, and occurs twice amonth. She is unable to correlate any patterns or triggersthat may cause to exacerbate her BMS. She deniesany taste disturbances, hot-flashes, night sweats, andperspiration. RESULT(S): Abnormalities during neurological examination were noted. Cranial nerves (CN) III, IV, and VIshowed bilateral lateral first degree end-gaze unsustained nystagmus. CN IX and X showed decreasedbilateral gag reflex. A right pronator drift with a rightabductor digiti minimi sign was seen in the motorexamination. The cerebellar examination was positivefor bilateral dysmetria during the Finger-To-Nose examination, and exhibited Holmes rebound phenomena,right more than left. Sensory examination showeddecreased light touch in the lower extremities, rightmore than left. Hoffman reflex was bilaterally positive.Mental status examinations demonstrated poor similarity interpretation and calculation ability. Her neuropsychiatric testing was normal, and included the Go-No-Goand Animal Fluency Testing. MRI of the brain exhibitedgliosis/laminar necrosis in the left inferior parietal lobe,and an 8mm descent of cerebellar tonsils below theforamen magnum. CONCLUSION(S): The potential mechanism for catamenialBMS is manyfold. Estrogen and progesterone both havenociceptive properties. Premenstrual drop or reductionof estrogen and progesterone may act to disinhibit pain[Vincent 2008], with pain modulation being moreeffective during the ovulatory phase (high estrogen andlow progesterone) [Rezaii 2012]. Depression in thepresence of Late Luteal Phase Dysphoric Disorder mayfunction to exacerbate the perception of underlying painthroughout the body, including the mouth and tongue.Decrease in estrogen and progesterone levels may alsoalter salivary output and composition. This may allowbaseline reduction of proprioceptive input on thetongue, thus acting through Melzack and Wall's GateControl Theory of Pain to disinhibit small C fibers, whichis perceived as burning pain [Melzack 1978]. Along withmenses, olfactory ability drops, and food preferences areoften reported to change [Keller 2013]. A decrease inestrogen and progesterone can also enhance trigeminalnerve sensitivity [Martin 2007], which exacerbates pain.This may indirectly influence or be associated with herBMS. Such observations justifies a trial of hormonalagents for therapy of BMS.