Neuralgias and Neuropathies in the Head and Neck Region

Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or terms of such damage”1. Head and neck areas the one of the most common locations to be involved in chronic pain conditions.

Neuralgia is a type of pain along the distribution of a specific nerve or nerves that are otherwise normal in function. Examples include – trigeminal neuralgia, glossopharyngeal neuralgia, occipital neuralgia, auriculotemporal neuralgia etc.

Common symptoms of neuralgia pain include:

  • Sharp electric shock like pain

  • Short duration

  • Paroxysmal

  • Episodic

  • Refractory period with no symptoms

  • Triggering factors and trigger zones

TRIGEMINAL NEURALGIA

Trigeminal Neuralgia is characterized by brief recurrent sharp electric shock like pain episodes along the distribution of the one or more divisions of the trigeminal nerve. The main divisions of the trigeminal nerve are ophthalmic (V1), maxillary (V2) and mandibular (V3) nerves.

POST HERPETIC NEURALGIA (PHN)

Post herpetic neuralgia is usually associated with acute herpes zoster infection. The infection usually presents as a rash which is painful but self-limited. There are 3 phases of the pain associated with herpes zoster infection:

  • Acute pain – refers to pain preceding or accompanying the eruption of the rash that may persist for up to 30 days

  • Subacute pain – refers to the pain that persists beyond the healing of the rash but resolves within three months of the onset

  • PHN - refers to pain persisting beyond three months from the initial onset of the rash

NEUROPATHIC PAIN

Neuropathic pain is defined as a disturbance in the function of a nerve or a pathologic change in a nerve. It could be secondary to trauma, pathology or lesion involving either the central or peripheral nervous system.

POST TRAUMATIC TRIGEMINAL NEUROPATHY

Post traumatic trigeminal neuropathy is characterized by oral or facial pain that is secondary to trauma to the trigeminal nerve, and is accompanied by additional signs or symptoms of trigeminal nerve dysfunction such as altered nerve sensation, hyper- or hypo-algesia, paresthesia, allodynia etc.

GLOSSOPHARYNGEAL NEURALGIA

Glossopharyngeal neuralgia consists of paroxysmal pain episodes occurring along the distribution of the glossopharyngeal nerve, and pharyngeal and auricular branches of the vagus nerve, affecting the back of the throat, base of the tongue, tonsillar fossa, ear canal, and the angle of the mandible areas. Pain episodes may last for weeks to months with the time between paroxysms ranging from minutes to hours. In a small percent of cases, patients may experience vagal symptoms such as bradycardia, syncope, hypotension and cardiac arrest. This is also known as vagoglossopharyngeal neuralgia.

GENICULATE NEURALGIA

Geniculate neuralgia is a type of facial neuralgia involving the nervus intermedius or intermedius nerve and manifests as deep inner pain. The pain episodes can be triggered by swallowing, cold, touch etc. Pain sometimes may be associated with changes in salivation and taste sensation.

1.      Merskey H. Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. Pain 1979;6(3):249.

2.      Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018; 38:1.

3.      Watson CP, Morshead C, Van der Kooy D, et al. Post-herpetic neuralgia: post-mortem analysis of a case. Pain 1988; 34:129.

4.      Blumenfeld A, Nikolskaya G. Glossopharyngeal neuralgia. Curr Pain Headache Rep 2013;17(7):343

5.      Alfieri A, Strauss C, Prell J, et al. History of the nervus intermedius of Wrisberg. Ann Anat 2010;192(3):139–44.