Neuralgia is a sharp pain that runs through the cranial nerves due to problems in them. We present the five types of neuralgia and their relevant clinical information.
Cranial nerves, also called cranial nerves, are a series of nerves that arise directly from the brain to be distributed through the holes at the base of the skull through the head, neck, thorax and abdomen.
These very important nervous components have various functions: from sight, smell, hearing and taste to neck movement and chewing, both motor and sensory nerves are essential for the perception of the three-dimensional space in which we find ourselves and for the functions that develop from the neck up.
Unfortunately, when any of these 12 cranial nerves fails or there are imbalances at the nervous levelin the individual in other areas, a very painful and annoying symptom called neuralgia can occur. The best-known type is trigeminal neuralgia, but there are a few more. Stay with us, because here we tell you everything you need to know about neuralgia and how to address them.
Neuralgia: sharp and frightening facial pain
Neuralgia is defined as a sharp and frightening pain that follows the route of a nerve and isdue to damage or irritation of it. If we dissect the term itself, we will discover that “algias” are pains of the skull and face. These algae (among which are the term that concerns us today) can be classified according to different parameters:
- Location: if the painful point is necessary we will be facing a neuralgia. On the other hand, if it occurs in a generalized way, it will be a migraine.
- Intensity: it must be quantified to what extent it challenges the correct development and routine of the patient.
- Type: the pain is electrical and acute in neuralgia, while migraines and vascular pain occur in a pulsatile manner.
- Triggers: unfortunately, in many cases it is idiopathic, that is, unknown.
- Duration of pain: neuralgia is brief, while headaches occur persistently.
- Digestive symptoms: common in migraines
As we can see, it is essential to differentiate a migraine or headache type pain from a neuralgia, but luckily it is easy. Headaches occur for longer, the pain is throbbing, other symptoms such as intestinal symptoms occur and the discomfort is more generalized, usually in one of the hemispheres of the face. On the other hand, neuralgia is like lightning, something like “stabbing” an important nerve in your face.
- You may be interested: “The 12 types of headache (symptoms, causes and treatment)”
The 5 types of neuralgia
Once we have learned to differentiate a neuralgia from other types of facial pain, it is time to describe the existing types. In total, we have collected 5:
- Trigeminal neuralgia.
- Postherpetic neuralgia.
- Arnold’s neuralgia.
- Intercostal neuralgia.
- Pudendal neuralgia.
Astrigeminal and postherpetic neuralgias are the most commonby far, let’s focus on the causes, symptoms and treatments of them. It should be noted that, although the term algia refers to the face, not all neuralgia responds to facial pain. We will see it in the following sections. Without further delay, we dissect these symptoms.
1. Trigeminal neuralgia
Trigeminal neuralgia (TN) is the most common type of facial pain in society andaffects up to 13 patients per 100,000 inhabitants. According to epidemiological studies, TN appears mostly in people over 50 years of age, especially women. Unfortunately it is a relatively common symptom in multiple sclerosis patients, as 1-2% of them present it.
Consequently, one of the most common causes of trigeminal neuralgia is sclerosis, since this pathology damages the protective myelin covering of nerves, exposing them to mechanical damage. Other underlying reasons may be tumors or blood vessels that compress the nerve or injuries to the neck and face that may have compromised some nerve structure. Even so, many cases are idiopathic in nature, that is, the causes are not known.
Symptoms
The symptoms of trigeminal neuralgia are characteristic. The clearest of them all is the appearance ofa sudden pain of about 5 to 20 seconds in the face, unilateral and experienced in one of the branches of the trigeminal nerve (hence its name, for one of the nerve cranial nerves). This pain is stabbing, lacerating and electroshock-like.
In a patient with NT, something as simple as shaving, touching their face, brushing their teeth, or eating can trigger those episodes of sudden electrical pain. Of course, it is a truly annoying symptom that can decrease the quality of life of the individual.
Treatment
In general, it is sought that the patient is able to alleviate painthrough anticonvulsant medications, over-the-counter analgesics or antidepressants. In the event that the pain is intense and continuous, you can go to a surgery that will try to separate the structure that is compressing the nerve from the nerve itself. Unfortunately, this cure is not absolute and definitive, because trigeminal neuralgia is relatively recurrent even after having undergone surgery.
2. Postherpetic neuralgia
On the other hand we have postherpetic neuralgia (PHN), a complication thatarises after infection with the herpes zoster virus. It is the most common clinical picture that follows shingles, as this virus can affect the nerve fibers of the skin, causing pain that may persist even if the typical herpes rash has already subsided. It affects 10% of those infected in the subacute phase of the disease and the chances of developing PHN are higher from 60 years of age.
Symptoms
Signs and symptoms of PHN usually occur in the area of the skin where the herpes zoster outbreak (also called shingles) occurred, that is, the area where the patient experienced a rash in the form of reddish blisters, usually located on one side of the trunk.
In order for the clinical picture to be considered a postherpetic neuralgia, it must have lasted three months or more after the rash has healed, have a soft touch sensitivityand cause an itching or numbness in the affected area. This pain is burning, constant, and can greatly hinder the patient’s ability to fall asleep and perform normal tasks.
Treatment
Unfortunately, there is no single treatment that completely eliminates PHN, just as trigeminal neuralgia does not go away easily. Anyway, in this case there are a number of methods a little more effective. We will see them above.
You can choose, for example, theuse of lidocaine or capsaicin patches, whose properties reduce pain in the affected area. As with NT, the patient may also be prescribed anti-seizure medications, antidepressants, opioid analgesics, or corticosteroid injections. The treatment is based on relieving the pain and the perception that the patient has about it, not on recovering the affected area, because today that is impossible.
3. Arnold’s neuralgia
Also known as occipital headache, it is a common disease due to the involvement of the greater occipital nerve in any area of its extension. It usually presents with occipital pain, stiff neckand sensation of hypersensitivity in the scalp.
4. Intercostal neuralgia
It presents with a mechanical pain that occursin the space between the ribs. The most common cause of this type of neuralgia is a spinal injury or sprain.
5. Pudendal neuralgia
Pudendal nerve neuralgia (PN) is a symptom characterized bychronic neuropathic pain that is aggravated when sittingand for which an organic cause cannot be identified by imaging studies, that is, it is of idiopathic origin. It is often associated with a malformation or mismatch at the pelvic level or trauma and injury.
Summary
As we have seen, the world of neuralgia is extensive and goes far beyond trigeminal neuralgia, the most common and widespread variant of all those listed. Unfortunately, most of these symptoms have no specific cause andtreatment is not foolproof, which is why the patient must learn to live with pain in one form or another.
References
- Craniofacial algae, Virtual ENT Training Book. Collected on November 6 in https://seorl.net/PDF/Nariz%20y%20senos%20paranasales/060%20-%20ALGIAS%20CRANEOFACIALES.pdf?boxtype=pdf&g=false&s=false&s2=false&r=wide
- Arahal, A., Poyato Borrego, M., Molero del Río, M., Rodríguez Rodríguez, M., & Mesa Rodríguez, P. (2017). Occipital neuralgia and its management in primary care. SEMERGEN, Soc. Esp. Med. Rural Gen. (Print Ed.), 243-244.
- Montero, A. A., & Carnerero, C. S. (2016). Update in the management of trigeminal neuralgia. SEMERGEN-Family Medicine, 42(4), 244-253.
- Trigeminal neuralgia, U.S. National Library of Medicine. Collected on November 6 in https://medlineplus.gov/spanish/ency/article/000742.htm
- Trigeminal neuralgia, manualMSD. Collected on November 6 in https://www.msdmanuals.com/es-es/hogar/enfermedades-cerebrales,-medulares-y-nerviosas/trastornos-de-los-pares-craneales/neuralgia-del-trig%C3%A9mino
- Trigeminal neuralgia, mayoclinic.org. Collected on November 6 at https://www.mayoclinic.org/es-es/diseases-conditions/trigeminal-neuralgia/symptoms-causes/syc-20353344
- Trigeminal neuralgia, middlesexhealth. Collected on November 6 in https://middlesexhealth.org/learning-center/espanol/enfermedades-y-afecciones/neuralgia-del-trig-mino
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.
