Why so many older women suffer the agony of burning mouth syndrome: DR MARTIN SCURR reveals the likely causes - and how you can treat it

I’ve been diagnosed with burning mouth syndrome and it’s extremely painful (it was caused by my ulcerative colitis). I’ve been put on gabapentin, but is this likely to help?

Audrey Boyson, Merton.

Dr Martin Scurr replies: Burning mouth syndrome might sound unusual, but in fact it’s not uncommon and I’ve seen it in a number of patients, all of whom have eventually become symptom-free.

It causes scalding, tingling symptoms that typically affect the tongue, lips and palate.

While it’s not known what triggers it, the most likely explanation is some abnormality in nerve function (involving the trigeminal nerve, which controls sensation and muscle movement in the face).

The condition most commonly affects post-menopausal women, which suggests that hormonal changes are involved.

Some patients with ulcerative colitis, a form of inflammatory bowel disease, develop burning mouth syndrome. This could be because of nutritional deficiency or the side-effects of medication, for instance. Treatment often starts with a low dose (10mg) of a tricyclic antidepressant drug called amitriptyline, which works by reducing abnormal signals being sent by damaged nerves. Improvement may take some weeks. After the first month or so, the dose may need to be increased to 25mg.

If amitriptyline doesn’t work, another option is clonazepam (a type of benzodiazepine) at a very low dose of 1mg at night.

Again, it can take time to work. But if this drug eases your symptoms, it must be continued long term, stopping every six or 12 months for a month to check if the problem has fully resolved.

Gabapentin is another treatment (usually started at a very low dose) for burning mouth syndrome.

While most cases will respond to treatment, for some people it can be a long-term disorder, especially as the pain can recur when medication is withdrawn.

In December I had an ‘episode’ where my face drooped and my speech slurred, but I recovered within minutes. That day I had a few episodes of weakness in my right leg, so eventually I went to A&E, but wasn’t given an MRI. Several days later my GP ordered one which showed I’d had a stroke and several TIAs, which my stroke consultant says is due to low blood pressure (it’s 104/64).

Carol Gritti, Nottingham.

Dr Martin Scurr replies: I am appalled by your story but hope that you are making a good recovery.

Normally, if a patient is suspected of having either a stroke or a transient ischemic attack (TIA, or mini stroke), they should have a CT scan within hours to consider the appropriate action. Clearly you did not have this, let alone an MRI, which would have confirmed a stroke.

Fortunately it seems in your case the delay in treatment has not had a long-term, harmful effect. I am surprised that the stroke consultant advised you that these episodes were due to low blood pressure. Normally, low blood pressure is not associated with a higher stroke risk; in fact, lowering raised blood pressure is the single most effective step for reducing that risk.

This makes me wonder, therefore, if there was another factor, in conjunction with your low blood pressure, that caused the events you have described.

Dehydration, for instance, combined with low blood pressure, can trigger a TIA or a stroke because of the added risk of a clot forming, as being dehydrated thickens the blood.

Other possibilities include a blood clotting tendency, or more obscure risk factors that your consultant didn’t mention.

The key for you in maintaining a healthy blood pressure is to remain well hydrated – avoiding the diuretic effect of too much coffee or tea – and concentrate on a wholesome, fresh food diet.