Cranial Neuralgias

PURPOSE OF REVIEW This article describes the clinical features and diagnostic criteria, pathophysiology (when known), and treatment strategies of the major cranial neuralgias.

RECENT FINDINGS Abnormal vascular loops compressing cranial nerves are the most common known pathogenesis associated with the primary neuralgias.

SUMMARY The most frequently encountered primary neuralgias are trigeminal neuralgia, occipital neuralgia, and, rarely, glossopharyngeal neuralgia. Nervus intermedius neuralgia is even more rare. All neuralgias merit a careful workup for secondary causes. Drug treatment generally relies on antiepileptic drugs, antidepressants, and baclofen. OnabotulinumtoxinA can be useful in treating some cranial neuralgias. Surgical and invasive treatments include ablation, gamma knife treatment, and microvascular decompression.

Address correspondence to Dr Stewart J. Tepper, Dartmouth Headache Center, Neurology Department, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, [email protected].

RELATIONSHIP DISCLOSURE: Dr Tepper has received personal compensation as editor-in-chief of the American Headache Society journal Headache Currents and has received personal compensation as a lecturer for CME. Dr Tepper has received personal compensation as a consultant for Acorda Therapeutics; Alder BioPharmaceuticals, Inc; Allergan; Amgen Inc; Autonomic Technologies, Inc; CEFALY Technology; Charleston Laboratories, Inc; DeepBench; Dr. Reddy’s Laboratories Ltd; ElectroCore, LLC; Eli Lilly and Company; eNeura Inc; Gerson Lehrman Group, Inc; Guidepoint Global, LLC; Impax; Neurolief Ltd; Novartis AG; Pfizer Inc; Scion NeuroStim LLC; Slingshot Insights; Supernus Pharmaceuticals, Inc; Teva Pharmaceutical Industries Ltd; and Zosano Pharma Corporation.Continued on page 1178 Dr Tepper receives research/grant support paid to his employer (no personal compensation) from Alder BioPharmaceuticals, Inc; Allergan; Amgen Inc; Autonomic Technologies, Inc; Avanir Pharmaceuticals, Inc; Dr. Reddy’s Laboratories Ltd; ElectroCore, LLC; eNeura Inc; Scion NeuroStim LLC; Teva Pharmaceutical Industries Ltd; and Zosano Pharma Corporation. Dr Tepper has stock options from Autonomic Technologies, Inc and receives royalties from Springer.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Tepper discusses the unlabeled/investigational use of all listed medications for the treatment of neuralgias.

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