HeadWise HeadWise: Volume 6, Issue | Page 13

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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