Pain arising from cranial neuralgias represents a significant health burden. Successful treatment depends on accurate diagnosis, which requires knowledge of neuroanatomy and pathophysiology as well as familiarity with the varied clinical presentations encountered in neurologic practice. This article delineates the relevant anatomy, clinical features, and management of the most common primary and secondary cranial neuralgias.
Trigeminal neuralgia, which can result from neurovascular compression or demyelination, is a particularly severe form of facial pain. Herpes zoster virus is a common cause of neuralgia that causes herpes zoster ophthalmicus acutely and postherpetic neuralgia chronically. Rarer facial pain syndromes arising from a single nerve include glossopharyngeal neuralgia, nervus intermedius neuralgia, and paratrigeminal oculosympathetic syndrome.
In patients presenting with a cranial neuralgia, unless the etiology is apparent (eg, herpes zoster), cranial imaging studies should be undertaken to look for structural abnormalities such as neoplasm, granulomatous disease, demyelinating disease, or vascular malformations. Management of both common and rare cranial neuralgias is often challenging and is best guided by the most recent available evidence.
Address correspondence to Dr William P. Cheshire Jr, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, firstname.lastname@example.org.
Relationship Disclosure: Dr Cheshire has received personal compensation for manuscript preparation from Turner White Communications, Inc.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Cheshire discusses the unlabeled/investigational use of oxcarbazepine, baclofen, phenytoin, fosphenytoin, gabapentin, botulinum toxin, tizanidine, pimozide, and motor cortex stimulation for the treatment of trigeminal neuralgia; tricyclics, pregabalin, opioids, tramadol, and capsaicin for the treatment of postherpetic neuralgia; carbamazepine, gabapentin, lamotrigine, and tricyclics for the treatment of nervus intermedius neuralgia; and nonsteroidal anti-inflammatory drugs, muscle relaxants, tricyclics, gabapentin, and occipital nerve stimulators for the treatment of occipital neuralgia.