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.
