Neuralgias

Neuralgias are a group of conditions characterized by sudden, severe, brief episodes of pain along the distribution of a sensory nerve. The attacks are typically described as stabbing, electric, or shooting, and between episodes patients may have little or no pain. Neuralgia represents a form of neuropathic pain arising from irritation, injury, or dysfunction of a cranial or peripheral nerve, and it can affect several different nerves.

The most well-known neuralgia is trigeminal neuralgia, which involves the fifth cranial nerve and causes unilateral facial pain that is often triggered by light touch, chewing, or talking. Other commonly described neuralgias include glossopharyngeal neuralgia, which causes throat, ear, or base-of-tongue pain; occipital neuralgia, involving the occipital nerves at the back of the head; and postherpetic neuralgia, a chronic pain syndrome following herpes zoster infection that can cause burning, shooting, or allodynic pain in affected dermatomes.

Pathophysiology varies by type. Trigeminal neuralgia is frequently linked to vascular compression and focal demyelination of the trigeminal nerve, while postherpetic neuralgia results from nerve damage after varicella-zoster infection. Diagnosis is primarily clinical, based on the location and character of pain and its triggers; imaging such as MRI may be used to exclude structural causes. In some cases diagnostic nerve blocks are employed to confirm neural involvement.

Treatment is individualized. First-line medical management typically includes anticonvulsants such as carbamazepine or oxcarbazepine, with alternatives like gabapentin or pregabalin, and sometimes antidepressants. For refractory or poorly tolerated cases, interventions such as nerve blocks, surgical options (microvascular decompression, rhizotomy, or focal lesioning), or stereotactic radiosurgery may be considered. The course and prognosis vary; many patients achieve substantial pain relief with appropriate therapy, while others experience persistent symptoms.