What is Neuralgia?
Neuralgia is a medical condition which results in spasmodic, chronic pain along a single nerve or group of nerves in the head and/or neck. Several main types are identified: trigeminal, postherpetic and occipital. More rarely, a person may be afflicted with glossopharyngeal neuralgia. Treatment depends upon type and cause and varies in success.
Trigeminal neuralgia (TN) begins with very painful, sharp spasms on one side of the face. The forehead, eyes, scalp, lips, nose or jaws can be affected, since the trigeminal nerve serves all these places. The trigeminal nerve, located in the cranium, is so named because it has pathways to three different areas of the face: ophthalmic, maxillary and mandibular. Initially, the spasms may occur infrequently, sometimes with several months between paroxysms. Ultimately, the area of pain will become hypersensitive and spasms will occur with greater frequency, until the simplest of activities, like eating or washing the face, may trigger an attack.
The underlying causes of trigeminal neuralgia are sometimes difficult to determine. Nerve damage can be challenging to spot on brain scans. Occasionally, such scans show that the trigeminal nerve is affected by a brain tumor, but often the cause of the pain is unknown. In the case of an operable tumor, surgery is generally preferred to hopefully provide a cure.
The first line of treatment for TN is anti-convulsant medications such as carbamazepine (Tegratol). Most pain medications, such as acetaminophen, codeine, or ibuprofen, with the exception of oxytocin, do not provide pain relief for those with neuralgia. In many cases, those suffering from this condition may also require anti-depressants to cope with the debilitating effects of the painful attacks and the isolation they may engender.
When medication is ineffective, other tactics are attempted. Steroids can be injected directly into the trigeminal nerve cluster or neurosurgeries can be attempted to relieve pressure. Such treatments risk worsening neuralgia instead of alleviating it. Others forgo traditional treatment and rely on herbal or alternative medicines to cope with pain.
A more elusive type of neuralgia, atypical trigeminal, is yet more difficult to identify and diagnose. Pain is more constant than that of TN, but the condition is often misdiagnosed as jaw problems, migraines, or hypochondria. Though less intense pain is common with this type, those afflicted have few remissions from the pain. Because of frequent misdiagnosis, the risk of suicide to seek an end from unrelenting pain is extremely high. Atypical trigeminal neuralgia is sometimes referred to as "suicide disease."
Conversely, postherpetic neuralgia is fairly easy to diagnose as it generally follows an attack of shingles, an adult form of the chickenpox virus. The pain, however, can be worse than shingles itself, and can continue for a few months or last for several years. The pain is usually located where the shingles rash initiated. Fortunately, not all those who develop shingles will develop neuralgia. Preferred treatments are the same medications used to treat trigeminal and other forms of the condition.
Occipital neuralgia results in spasms of pain to the back, front and sides of the head and can be caused by spinal injury, such as whiplash, compression of nerves in the spinal column or occasionally by gout or diabetes. The glossopharyngeal type causes pain to the throat, tongue, tonsils and occasionally the ears. Treatment for occipital neuralgia comprises a combination of pain medications, steroid injections and physical therapy, while glossopharyngeal treatment follows the methods used for TN. If oral prescriptions fail, medications may be injected to block the nerve's reaction for both of these types of neuralgia.
In all the above listed forms, women are more at risk than men. Most cases involve patients over 50. Neuralgia is not fatal, but can indicate a condition that is. Multiple sclerosis can cause compression of the nerves and lead to TN. Glossopharyngeal neuralgia may signify decreased heart function and eventual heart failure. Since the stress associated with chronic pain often leads to depression, there are many communities online and off in which those suffering from neuralgia can gain both information and support.
I recently went through an episode of shingles in and around the eye (42 year old healthy male) this last April. The onset was sudden, pain started on Sunday and the shingles were full blown by the following Saturday. I went to my primary doctor three times, an eye doctor once and the ER once in the space of four days, only to have all of them scratch their heads wondering what the issue was.
Only on day five and a second visit to the ER with the infection starting to scab over on the left side of my face was I told it was shingles -- by a physician's assistant. This was in April and fast forward to August and my skin has cleared up with scaring around the eye, but I am still fighting sight issues relating to ulcers on my cornea, eye pain from shingles in my eye (at least that's the best explanation my eye doctor can give me) and nerve pain associated with shingles around my eye. The eye pain has been pretty manageable. I can take a norco or 800mg of ibuprofen and I can manage. The facial nerve pain, though, is by far the worst. I will have moments where there is no pain and all of a sudden the pain just explodes. I have nights where the pain will wake me from sleep in the middle of the night. I am taking Gabapentin for this nerve pain and it does seem to help some, but I have times where literally nothing happens and my pain is still set off. Unfortunately nothing helps completely either. I was even told to try Capsacian (found in pepper spray) for the nerve pain. The problem is that it burns when put on the skin and I had to put it on the most sensitive spot on my face, the skin around my eye. Again, it did help some, but it seems nothing will completely take the nerve pain away.
I am curious if anyone else has suffered shingles in this way like I have, and if so, what you may have done to help with the pain. At this point I'm going to a specialist at Stanford for my issues with my eye, but I am starting to wonder if I need to start seeing a never specialist as well. --Matt
This article gives good information which also covers chronic pain due to trigeminal nerve compression. I suffer from a similar condition which I have pasted below. As I am not getting diagnosed and hence not being treated properly, I request any doctor who may be interested in helping me to suggest an appropriate course of action.
Subjective Symptoms: I have had constant, aching pain in the front upper portion of both eyes (just above the sclero-corneal junction) extending to the top of the head (Vertex) through the temples, 24 hours a day for over 30 years. I have also pain and a brittle sensation while looking up. Both the eyes are affected. There is a sensation of pressure on both eyes, on the left greater than on the right. There is a crescent area under my lower eye lids where a pulling inward sensation with pain is felt. My vision is slightly blurred even after wearing spectacles and when I look at the Amsler grid, there is also a slight distortion of the squares. These conditions are always accompanied by bilateral tinnitus with humming noise.
My pain level is about 5 on a scale of 10. There is a slight variation of pain in different periods in a day. Along with this, I feel my neck muscles are always stiff and rigid and there is a constant feeling of pulling on my spine upwards towards the brain. Often I feel pain in one or two upper/lower teeth without any dental problems. Sometimes I grind my teeth when I sleep. Since I have vertebral disc compression at L4/5 levels, the pull on the spine induces pain in the front portion of my thighs. When the problem started years ago, all these conditions were present but to a lesser degree.
My sleep is disturbed and with sleeping pills, I've been getting about four or five hours sleep for the last eight years. Initially when the problem started, I used to sleep until 3 a.m. and gradually over the years, it has reduced to no sleep at all now. I have been a Type 2 diabetic for the last eight years and my blood sugar levels are under control.
The opinion of the Ophthalmologists and neuro-physicians are Myopic fundus with completed PVD. Refractive power of -5 diopters, No other significant abnormality detected. They have advised me to see a neurologist.
This has been very helpful. I don't know which one I have since my pain is the side of the head, not the scalp. It is very scary.
I have been having facial nerve pain on my left side for a few weeks now. I am up right now as I write this because the pain is so intense I cannot sleep.
It comes on very suddenly and lasts a good two or three hours, then subsides a little but still causes some pain. It is really unbearable when these attacks happen. I am taking muscle relaxers and prescription Advil but it takes a while to kick in.
I was told several years ago I have TMJ issues, but have had it under control for a long time. I think this is something different. It feels very nerve like and stays on the one side. Drinking water or anything just makes it worse.
What can be done? This is really starting to affect my quality of life. What should I start with as far as helping myself? My dentist always blames my uneven bite, but never really gives me answers. Should I start with my primary care doctor and get testing done? Thanks for any help. I do have a night guard, so that is not what is wrong. I also have Fibromyalgia, so I'm not sure it is connected.
I have Occipital Neuralgia, was diagnosed with it in 2010, but have had it for longer. At first, I was put on a lot of prescriptions and physical therapy. The prescriptions wrecked the rest of my body though to help my pain.
In Feb 2011, I started a preventive program using cannabis for Occipital Neuralgia and not a single prescription drug (not even over the counter drugs like Tylenol or IB). I have been using cannabis consistently every day for over a year now, and it has done more towards my health than the prescriptions I was on would ever have done. It has an almost direct correlation in managing my headaches and I use it along with mindful meditation and yoga to manage.
It's not easy, but I feel a whole lot better with a clean system that isn't dependent on pharmaceuticals. I hope those with nerve-oriented pain will look into this option that should be more readily available. Just make sure you get high CBD, grounding, indica-types. The more THC and sativa often makes the nerves jittery and further heightens the sensitivity. Also explore options like teas, salves, concentrates, etc.
I've had occipital neuralgia for at least 10 years. I've learned only recently that it stems from issues with my back and previous injuries as a teenager. Completely unrelated, I was put on Lamictal for mood swings several years ago. My headaches went away! I don't know if it's a tested medication for it, but it really worked for me. Just putting it out there.
I had left side of face pain,thought it was dental .An x-ray at the dentist revealed it was a sinus infection. A prescription of antibiotics has helped but a second round was necessary as i was still getting pain. It's worth checking out with the dentist as a doctor/local GP can't always diagnose this condition without an x-ray of the mouth and nasal passages.
I've been having a lot of pain on the right side of my face just under my eye and in my teeth. It's been nine weeks of pain. I've been to the dentist seven times and had three teeth out. but still in a lot of pain. The pain is there all the time; it never goes away.
My teeth are killing me. I just want them all out. All i do is cry with pain my face hurts so bad.
I have shooting and throbbing nerve pain in my left arm. It is indescribable and so hard to function my daily life. I have been diagnosed with shingles and i am only 37. I also have bulging discs in my neck and stenosis and osteo.
I have had pain in my wrist for the last one year. I had doubt about CTS but the doctor said it is neuralgia. The pain is in the right hand wrist just a half inch below the palm in the left corner. The pain starts once I place my hand on the surface and try to move my wrist to the left.
Hi, I been having pain in my right ear and throw right arm and down to the leg for a long time. But now I have noticed that when air hits me it gets worse. You think it is a type of neuralgia?
I had shingles in my head last winter lasting about 3 months. I have had for the last 4 weeks intermittent pain in my head, very sharp also in the side of my face running through to the jaw with sore gums that feel inflamed. The dentist has X-rayed and found some inflammation under some teeth but assures me my teeth are not the problem. the pain comes and goes. some days it hardly affects me. other days, like today, it's extremely painful. warmth seems to help. any advice would be gratefully received. my thanks to you. --R H
Is it possible to have more than one type of cranial neuralgia, such as Occipital Neuralgia and Glossopharyngeal Neuralgia, or Occipital Neuralgia and Geniculate Neuralgia?
I am having classic symptoms of Occipital Neuralgia, but I also have pain deep in my ear and throat (especially when I swallow).
Hi, a was recently diagnosed as having neuralgia of the n.nasociliaris, after two years of constant pain and a lots of misdiagnoses. On the base of all the examinations the cause for that is hypertrophy of the nasal barrier. The pain is awful, situated between the right eye and the nose... What is the treatment for this type of neuralgia? Is there a chance to vanish?
hi, my mother removed one of her wisdom teeth and ever since she has pain that comes and goes, it's a form neuralgia but it's never constant but it comes last a few seconds and goes sometimes it's more frequent then other times. It's been two to three years since she removed her wisdom teeth and the doctor has to use a lot of injections to freeze the area before he could get it out. Was the damage caused by this??
Post your comments