Cranial Neuralgias
Ashley Holdridge, D. O. Medical Director The Comprehensive Headache Center Wheaton Franciscan Healthcare Franklin, WI
Painful cranial neuralgias( nerve pain) and other facial pains create puzzling presentations with many overlapping features. Due to the complicated anatomy of the head and neck, many patients experiencing cranial neuralgia and other facial pains have consulted multiple physicians. Often, these patients have undergone elective procedures that leave them feeling worse than when they started. The patients will describe excruciatingly painful episodes that trigger both physical and emotional turmoil for the individual as well as their families.
By definition, a cranial neuralgia is: a paroxysmal( recurrent), brief, intense, lightning-like pain within the distribution of a particular cranial nerve. Cranial nerves originate in the brainstem. The most frequently encountered types of cranial neuralgias are trigeminal neuralgia( TN), glossopharyngeal neuralgia( GPN), and nervus intermedius neuralgia( NIN).
Other unusual pains with neuralgic components will also be described in this article in consideration of the overlap in symptoms that the patient will often encounter.
Trigeminal Neuralgia( TN) involves facial pain in the area of the trigeminal nerve. It affects around 5.7 per 100,000 women and 2.5 per 100,000 men. The peak incidence of TN occurs between the ages of 50 to 60 years with the prevalence increasing with age. When a cause for TN can be identified, the result is usually from a blood vessel putting pressure on the trigeminal nerve( which is also known as cranial nerve V). The pain may also be due to a problem with nerve insulation – the process being called demyelination.
Typically, TN is only found on one side of the face but can involve both sides of the face( bilateral). Patients have described the pain of TN as,“ plugged into the mains and switched on and off” and“ rockets and explosions.” Patients may complain of multiple stereotypical attacks per
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