Abstract
Purpose of Review
External nasal neuralgia is a rare syndrome of atypical facial pain for which there is limited reports in the scientific literature. We aim to review diagnosis and provide an update on treatments for this rare condition.
Recent Findings
Etiology has been documented as post-traumatic due to direct trauma to the nose area and in few case reports, idiopathic. Sensory innervation of the nose arises from the ophthalmic and maxillary divisions of the trigeminal nerve. Direct injury to the nerve appears to be the etiology of post-traumatic external nasal neuralgia. Pathophysiology for idiopathic nasal neuralgia is poorly understood but it appears to be of a central etiology given lack of response to intranasal anesthetics. Pain can be episodic with episodes of tingling sensation lasting up to 30 min, two to three times per day, but for some patients it can be constant bruised sensation of mild to moderate pain. Diagnostic workup including magnetic resonance imaging of brain and computerized tomography of the sinuses are usually negative, but there have been few cases of a nasal contact point. Routine blood work including erythrocyte sedimentation rate is negative.
Summary
Treatment for this rare condition is varied with very few patients responding to tricyclic antidepressants, specifically amitriptyline. Another medication used as prevention is pregabalin with good results as well. Most patients respond to nerve blockade with local anesthetic to the external nasal nerve and sphenopalatine ganglion block and radiofrequency ablation. More reports of this condition need to be published in the scientific literature to assist with proper diagnosis and treatment of this condition.
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Papers of particular interest, published recently, have been highlighted as: •• Of major importance
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Hida Nierenburg and Morgane Swift Morris declare that they have no conflict of interest.
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Case Illustration
A 50-year old female reports suddenly developing pain at the apex of the nose that radiated bilaterally to the side of the nose. Pain is intermittent, described as a tingling sensation but can be intense, disabling sharp pain at times. There is no associated photophobia, osmophobia, phonophobia, nausea, emesis, vision changes, conjunctival injection, ptosis, rhinorrhea, or congestion. Patient also denies numbness or tingling. There is no fever associated with symptoms. Physical examination including rhinoscopy is within normal limits. Diagnostic workup including CT of the nasal cavity and MRI are within normal limits. ESR and CRP are within normal range.
*Case is fictional and for illustrative purposes only
This article is part of the Topical Collection on Uncommon and/or Unusual Headaches and Syndromes
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Nierenburg, H., Morris, M.S. External Nasal Neuralgia: an Update. Curr Pain Headache Rep 21, 44 (2017). https://doi.org/10.1007/s11916-017-0645-5
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DOI: https://doi.org/10.1007/s11916-017-0645-5