Abstract
The neuralgias are characterized by pain in the distribution of a cranial or cervical nerve. While most often brief, severe, and paroxysmal, continuous neuropathic pain may occur. The most commonly encountered entities include trigeminal, postherpetic, glossopharyngeal, and occipital neuralgia. More unusual cranial neuralgias may occur in periorbital (eg, supraorbital neuralgia) and auricular (eg, nervus intermedius neuralgia) distributions. These disorders may be mimicked by structural and inflammatory/infectious neurologic disease, along with other primary headache disorders (eg, primary stabbing headache). The approach to diagnosis and treatment of this group of headache disorders is reviewed.
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Smith JH, Cutrer FM. Numbness matters: a clinical review of trigeminal neuropathy. Cephalalgia. 2011;31:1131–44.
Headache Classification Committee of the International Headache Society. The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808. Recent revision of the ICHD-2 2004 headache diagnostic criteria.
Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain. Subcommittee on Taxonomy. Pain Suppl. 1986;3:S1–226.
De Simone R, Ranieri A, Bilo L, et al. Cranial neuralgias: from physiopathology to pharmacological treatment. Neurol Sci. 2008;29 Suppl 1:S69–78.
Love S, Coakham HB. Trigeminal neuralgia: pathology and pathogenesis. Brain. 2001;124(Pt 12):2347–60.
Manzoni GC, Torelli P. Epidemiology of typical and atypical craniofacial neuralgias. Neurol Sci. 2005;26 Suppl 2:s65–7.
Katusic S, Beard CM, Bergstrahl E, et al. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. Ann Neurol. 1990;27:89–95.
Watson CP. Postherpetic neuralgia. Neurol Clin. 1989;7:231–48.
Katusic S, Williams DB, Beard CM, et al. Incidence and clinical features of glossopharyngeal neuralgia, Rochester, Minnesota, 1945-1984. Neuroepidemiology. 1991;10:266–75.
Koopman JS, Dieleman JP, Huygen FJ, et al. Incidence of facial pain in the general population. Pain. 2009;147:122–7.
Gronseth G, Cruccu G, Alksne J, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008;71:1183–90.
Bahgat D, Ray DK, Raslan AM, et al. Trigeminal neuralgia in young adults. J Neurosurg. 2011;114:1306–11.
Pollack IF, Jannetta PJ, Bissonette DJ. Bilateral trigeminal neuralgia: a 14-year experience with microvascular decompression. J Neurosurg. 1988;68:559–65.
Rozen TD, Capobianco DJ, Dalessio DJ. Cranial neuralgias and other causes of facial pain. In: Silberstein SD, Lipton RB, Dodick DW, editors. Wolff's Headache and other head pain. New York: Oxford University Press; 2008. p. 633–50.
Fromm GH, Graff-Radford SB, Terrence CF, et al. Pre-trigeminal neuralgia. Neurology. 1990;40:1493–5.
Rushton JG, Macdonald HN. Trigeminal neuralgia: special considerations of nonsurgical treatment. J Am Med Assoc. 1957;165:437–40.
Zhang J, Yang M, Zhou M, et al. Non-antiepileptic drugs for trigeminal neuralgia. Cochrane Database Syst Rev. 2013;12, CD004029.
Lechin F, van der Dijs B, Lechin ME, et al. Pimozide therapy for trigeminal neuralgia. Arch Neurol. 1989;46:960–3.
Wu CJ, Lian YJ, Zheng YK, et al. Botulinum toxin type A for the treatment of trigeminal neuralgia: results from a randomized, double-blind, placebo-controlled trial. Cephalalgia. 2012;32:443–50.
Hu Y, Guan X, Fan L, et al. Therapeutic efficacy and safety of botulinum toxin type A in trigeminal neuralgia: a systematic review. J Headache Pain. 2013;14:72.
Cheshire WP. Fosphenytoin: an intravenous option for the management of acute trigeminal neuralgia crisis. J Pain Symptom Manag. 2001;21:506–10.
Arai YC, Hatakeyama N, Nishihara M, et al. Intravenous lidocaine and magnesium for management of intractable trigeminal neuralgia: a case series of nine patients. J Anesth. 2013;27:960–2.
Zakrzewska JM, Akram H. Neurosurgical interventions for the treatment of classical trigeminal neuralgia. Cochrane Database Syst Rev. 2011:CD007312.
Barker FG, 2nd, Jannetta PJ, Bissonette DJ, et al. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334:1077–83.
Amador N, Pollock BE. Repeat posterior fossa exploration for patients with persistent or recurrent idiopathic trigeminal neuralgia. J Neurosurg. 2008;108:916–20.
Gorgulho AA, De Salles AA. Impact of radiosurgery on the surgical treatment of trigeminal neuralgia. Surg Neurol. 2006;66:350–6.
Kondziolka D, Zorro O, Lobato-Polo J, et al. Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg. 2010;112:758–65.
Revuelta-Gutierrez R, Martinez-Anda JJ, Coll JB, et al. Efficacy and safety of root compression of trigeminal nerve for trigeminal neuralgia without evidence of vascular compression. World Neurosurg. 2013;80:385–9.
Broggi G, Ferroli P, Franzini A, et al. Operative findings and outcomes of microvascular decompression for trigeminal neuralgia in 35 patients affected by multiple sclerosis. Neurosurgery. 2004;55:830–8. discussion 838–9.
Ariai MS, Mallory GW, Pollock BE. Outcomes after microvascular decompression for patients with trigeminal neuralgia and suspected multiple sclerosis. World Neurosurg. 2014;81(3-4):599–603
Resnick DK, Janneta PJ, Lunsford LD, et al. Microvascular decompression for trigeminal neuralgia in patients with multiple sclerosis. Surg Neurol. 1996;46:358–61. discussion 361–2.
Zorro O, Lobato-Polo J, Kano H, et al. Gamma knife radiosurgery for multiple sclerosis-related trigeminal neuralgia. Neurology. 2009;73:1149–54.
Yawn BP, Gilden D. The global epidemiology of herpes zoster. Neurology. 2013;81:928–30.
Ragozzino MW, Melton LJ, 3rd, Kurland LT, et al. Population-based study of herpes zoster and its sequelae. Medicine. 1982;61:310–6.
Birlea M, Nagel MA, Khmeleva N, et al. Varicella-zoster virus trigeminal ganglioneuritis without rash. Neurology. 2014;82:90–2.
Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352:2271–84.
Schmader KE, Levin MJ, Gnann JW, Jr et al. Efficacy, safety, and tolerability of herpes zoster vaccine in persons aged 50–59 years. Clin Infect Dis. 2012;54:922–8.
Chen N, Li Q, Yang J, et al. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2014;2, CD006866.
Dubinsky RM, Kabbani H, El-Chami Z, et al. Practice parameter: treatment of postherpetic neuralgia: an evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2004;63:959–65.
Kochar DK, Garg P, Bumb RA, et al. Divalproex sodium in the management of postherpetic neuralgia: a randomized double-blind placebo-controlled study. QJM. 2005;98:29–34.
Quan D, Hammack BN, Kittelson J, et al. Improvement of postherpetic neuralgia after treatment with intravenous acyclovir followed by oral valacyclovir. Arch Neurol. 2006;63:940–2.
Blumenfeld A, Nikolskaya G. Glossopharyngeal neuralgia. Curr Pain Headache Rep. 2013;17:343.
Minagar A, Sheremata WA. Glossopharyngeal neuralgia and MS. Neurology. 2000;54:1368–70.
Bruyn GW. Glossopharyngeal neuralgia. Cephalalgia. 1983;3:143–57.
Rushton JG, Stevens JC, Miller RH. Glossopharyngeal (vagoglossopharyngeal) neuralgia: a study of 217 cases. Arch Neurol. 1981;38:201–5.
Reddy K, Hobson DE, Gomori A, et al. Painless glossopharyngeal "neuralgia" with syncope: a case report and literature review. Neurosurgery. 1987;21:916–9.
Mason III JO, Katz B, Greene HH. Severe ocular pain secondary to occipital neuralgia following vitrectomy surgery. Retina. 2004;24:458–9.
Hammond SR, Danta G. Occipital neuralgia. Clin Exp Neurol. 1978;15:258–70.
Lord SM, Barnsley L, Wallis BJ, et al. Third occipital nerve headache: a prevalence study. J Neurol Neurosurg Psychiatry. 1994;57:1187–90.
Vanelderen P, Lataster A, Levy R, et al. Occipital neuralgia. Pain Pract. 2010;10:137–44.
Boes CJ. C2 myelitis presenting with neuralgiform occipital pain. Neurology. 2005;64:1093–4.
Kemp III WJ, Tubbs RS, Cohen-Gadol AA. The innervation of the scalp: a comprehensive review including anatomy, pathology, and neurosurgical correlates. Surg Neurol Int. 2011;2:178.
Saunders RL, Weider D. Tympanic membrane sensation. Brain. 1985;108(Pt 2):387–404.
Caminero AB, Pareja JA. Supraorbital neuralgia: a clinical study. Cephalalgia. 2001;21:216–23.
Mulero P, Guerrero AL, Pedraza M, et al. Non-traumatic supraorbital neuralgia: a clinical study of 13 cases. Cephalalgia. 2012;32:1150–3.
Sjaastad O, Stolt-Nielsen A, Pareja JA, et al. Supraorbital neuralgia. On the clinical manifestations and a possible therapeutic approach. Headache. 1999;39:204–12.
Taylor RW, Samuels HS. Neuralgia involving the infraorbital nerve: report of case. J Oral Surg. 1952;10:248–50.
Lopez Mesonero L, Pedraza Hueso MI, Herrero Velazquez S, et al. Infraorbital neuralgia: a diagnostic possibility in patients with zygomatic arch pain. Neurologia. 2013;33:1198–202.
Pareja JA, Cuadrado ML. Lacrimal neuralgia: so far, a missing cranial neuralgia. Cephalalgia. 2013;33:1198–202.
Cuadrado ML, Aledo-Serrano A, Jorquera M, et al. A new lacrimal neuralgia, a new nerve blockade procedure. Cephalalgia. 2014;13:812–4.
Carroll RP. Blindness following lacrimal nerve block. Ophthalmic Surg. 1982;13:812–4.
Speciali JG, Goncalves DA. Auriculotemporal neuralgia. Curr Pain Headache Rep. 2005;9:277–80.
Pomprasit M, Chintrakarn C. Treatment of Frey's syndrome with botulinum toxin. J Med Assoc Thai. 2007;90:2397–402.
Rustemeyer J, Eufinger H, Bremerich A. The incidence of Frey's syndrome. J Craniomaxillofac Surg. 2008;36:34–7.
Ansari H, Robertson CE, Jane JI, et al. Auriculotemporal neuralgia secondary to TMJ synovial cyst: a rare presentation of a rare entity. Headache. 2013;53:1662–5.
Smith JH, Robertson CE, Garza I, et al. Triggerless neuralgic otalgia: a case series and systematic literature review. Cephalalgia. 2013;33:914–23.
Pareja JA, Ruiz J, de Isla C, et al. Idiopathic stabbing headache (jabs and jolts syndrome). Cephalalgia. 1996;16:93–6.
Liang X, Ying G, Huang Q, et al. Characteristics of primary stabbing headache in a tertiary neurological clinic in China. Pain Med. 2014;24:993–6.
Franca Jr MC, Costa AL, Maciel Jr JA. Gabapentin-responsive idiopathic stabbing headache. Cephalalgia. 2004;24:993–6.
Jacome DE. Exploding head syndrome and idiopathic stabbing headache relieved by nifedipine. Cephalalgia. 2001;21:617–8.
Rozen TD. Melatonin as treatment for idiopathic stabbing headache. Neurology. 2003;61:865–6.
Fusco C, Pisani F, Faienza C. Idiopathic stabbing headache: clinical characteristics of children and adolescents. Brain Dev. 2003;25:237–40.
Pareja JA, Cuadrado ML, Caminero AB, et al. Duration of attacks of first division trigeminal neuralgia. Cephalalgia. 2005;25:305–8.
Pareja JA, Baron M, Gili P, et al. Objective assessment of autonomic signs during triggered first division trigeminal neuralgia. Cephalalgia. 2002;22:251–5.
Lain AH, Caminero AB, Pareja JA. SUNCT syndrome: absence of refractory periods and modulation of attack duration by lengthening of the trigger stimuli. Cephalalgia. 2000;20:671–3.
Paliwal VK, Singh P, Kumar A, et al. Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) with preserved refractory period: report of three cases. J Headache Pain. 2012;13:167–9.
Cohen AS, Matharu MS, Goadsby PJ. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or cranial autonomic features (SUNA)—a prospective clinical study of SUNCT and SUNA. Brain. 2006;129(Pt 10):2746–60.
Benoliel R, Sharav Y. Trigeminal neuralgia with lacrimation or SUNCT syndrome? Cephalalgia. 1998;18:85–90.
Rinaldi F, Rao R, Venturelli E, et al. Where SUNCT contacts TN: a case report. Headache. 2013;53:1492–5.
Pareja JA, Kruszewski P, Sjaastad O. SUNCT syndrome: trials of drugs and anesthetic blockades. Headache. 1995;35:138–42.
Pareja JA, Alvarez M. The usual treatment of trigeminal autonomic cephalalgias. Headache. 2013;53:1401–14.
Sebastian S, Schweitzer D, Tan L, et al. Role of trigeminal microvascular decompression in the treatment of SUNCT and SUNA. Curr Pain Headache Rep. 2013;17:332.
Lambru G, Shanahan P, Watkins L, et al. Occipital nerve stimulation in the treatment of medically intractable SUNCT and SUNA. Pain Physician. 2014;17:29–41.
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Paul M. Gadient and Jonathan H. Smith declare that they have no conflict of interest.
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Gadient, P.M., Smith, J.H. The Neuralgias: Diagnosis and Management. Curr Neurol Neurosci Rep 14, 459 (2014). https://doi.org/10.1007/s11910-014-0459-3
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DOI: https://doi.org/10.1007/s11910-014-0459-3