Many physicians don't recognize that these blushing episodes are commonly associated with hyperpyrexia of the face which is actually what is so debilitating and causes the severe functional impairment. The combination of facial blushing with the warm/burning sensation of the head commonly makes the individual extremely anxious and quite uncomfortable. This uncomfortable feeling can be so intense that the individual can lose all ability to concentrate and function appropriately.

Medications commonly used to prevent or control blushing include beta blockers (Inderal) and anxiolytics (sedatives). These medications are usually of limited benefit in reducing blushing intensity and frequency of episodes.

Effective treatment for facial blushing with hyperpyrexia is Micro ETS of T2. Precise division of the sympathetic nerve exactly where it crosses the upper edge of the second rib and any kuntz nerve branches present crossing the second thoracic rib as well. Dividing all kuntz nerves as they cross the second thoracic rib is essential for successful treatment of facial blushing.

Persistent facial blushing after sympathectomy can occur if any kuntz nerve that crosses the second thoracic rib is left intact, and can therefore continue to carry nerve signals to the face.

In the many redo's Dr. Nielson has performed for persistent facial blushing, he has found that the most common reason for persistent blushing has been missed Kuntz nerves crossing the second thoracic rib and less commonly dividing the sympathetic nerve at the T3 level by mistake rather than the T2 level.