Cranial Neuralgias

Carrie Robertson, MD, FAHS Headache p. 665-685 June 2021, Vol.27, No.3 doi: 10.1212/CON.0000000000000962
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PURPOSE OF REVIEW This article discusses the differential diagnosis, evaluation, and management of trigeminal neuralgia and reviews other neuralgias of the head and neck, including those that contribute to neuralgic ear pain.

RECENT FINDINGS Most cases of trigeminal neuralgia are related to vascular compression, a demyelinating plaque, or a compressive mass affecting the trigeminal nerve. However, recent studies have shown that up to 11% of patients have a family history of trigeminal neuralgia, suggesting that some patients may have a genetic predisposition to demyelination or nerve hyperexcitability. In these patients, trigeminal neuralgia may occur at a younger age, on both sides of the face, or in combination with other neuralgias.

SUMMARY When a patient presents with neuralgic pain, the diagnosis is made by careful history and neurologic examination, with attention to the dermatome involved, the triggers, and the presence of any associated sensory deficit. All patients with new neuralgia or neuropathic facial pain warrant a careful evaluation for a secondary cause. The presence of sensory deficit on bedside examination is particularly concerning for an underlying secondary etiology.

Address correspondence to Dr Carrie Robertson, 200 First St SW, Rochester, MN 55905, [email protected].

RELATIONSHIP DISCLOSURE: Dr Robertson serves on advisory boards for Alder BioPharmaceuticals, Inc; Biohaven Pharmaceuticals; and Impel NeuroPharma, Inc, and receives publishing royalties from UpToDate Inc.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Robertson discusses the unlabeled/investigational use of treatments for trigeminal neuralgia, none of which are US Food and Drug Administration approved for this indication, except for carbamazepine.

© 2021 American Academy of Neurology.