Neuralgia causes chronic pain along a single nerve or group of nerves in the head and neck. Trigeminal neuralgia is the most common type, causing sharp spasms on one side of the face. Treatment depends on the type and cause, and may include anticonvulsant drugs, surgery, or alternative medicines. Atypical trigeminal pain is difficult to diagnose and can lead to suicide. Postherpetic neuralgia follows an attack of shingles, while occipital and glossopharyngeal neuralgia cause pain in the head and throat respectively. Women over 50 are most at risk.
Neuralgia is a medical condition that causes chronic, spasmodic pain along a single nerve or a group of nerves in the head and/or neck. Several main types are identified: trigeminal, postherpetic, and occipital. More rarely, a person may be afflicted with glossopharyngeal neuralgia. Treatment depends on the type and cause, and varies based on success.
Trigeminal neuralgia (TN) starts with very painful, sharp spasms on one side of the face. The forehead, eyes, scalp, lips, nose, or jaws may be affected, as the trigeminal nerve serves all of these places. The trigeminal nerve, located in the skull, is so named because it has pathways to three different areas of the face: ophthalmic, maxillary, and mandibular. Initially, the spasms may occur infrequently, sometimes with several months between paroxysms. Eventually, the area of pain will become hypersensitive and the spasms will occur more frequently, until simpler activities, such as eating or washing the face, can trigger an attack.
The underlying causes of trigeminal neuralgia are sometimes difficult to determine. Nerve damage can be difficult to spot on brain scans. Occasionally, these scans show that the trigeminal nerve is affected by a brain tumor, but often the cause of the pain is unknown. In the case of an operable tumor, surgery is usually preferred to provide a cure.
The first line of treatment for TN is anticonvulsant drugs such as carbamazepine (Tegratol). Most pain medications, such as acetaminophen, codeine, or ibuprofen, with the exception of oxytocin, do not provide pain relief for people with neuralgia. In many cases, sufferers of this condition may also need antidepressants to cope with the debilitating effects of painful attacks and the isolation they can generate.
When the drug is ineffective, other tactics are tried. Steroids may be injected directly into the trigeminal nerve cluster or neurosurgery may be attempted to relieve the pressure. Such treatments risk making neuralgia worse instead of relieving it. Others forgo traditional treatment and rely on herbal or alternative medicines to cope with the pain.
A more elusive type of neuralgia, atypical trigeminal pain, is even more difficult to identify and diagnose. The pain is more constant than that of TN, but the condition is often misdiagnosed as jaw problems, migraines, or hypochondriasis. Although less intense pain is common with this type, sufferers have little pain relief. Due to frequent misdiagnoses, the risk of suicide from trying to end unrelenting pain is extremely high. Atypical trigeminal neuralgia is sometimes referred to as a “suicide disease.”
In contrast, postherpetic neuralgia is fairly easy to diagnose as it generally follows an attack of shingles, an adult form of the chickenpox virus. The pain, however, can be worse than the shingles itself and can continue for a few months or last for several years. The pain is usually found where the shingles rash started. Fortunately, not everyone who develops shingles will develop neuralgia. The preferred treatments are the same medications used to treat trigeminal and other forms of the condition.
Occipital neuralgia causes spasms of pain in the back, front and sides of the head and can be caused by spinal injuries, such as whiplash, compression of nerves in the spine, or occasionally gout or diabetes. The glossopharyngeal type causes pain in the throat, tongue, tonsils, and occasionally the ears. Treatment for occipital neuralgia includes a combination of pain medications, steroid injections, and physical therapy, while glossopharyngeal treatment follows the methods used for TN. If oral prescriptions fail, drugs can be injected to block the nerve’s reaction for both of these types of neuralgia.
In all of the forms listed above, women are more at risk than men. Most cases involve patients over the age of 50. Neuralgia isn’t fatal, but it can indicate a condition that is. Multiple sclerosis can cause nerve compression and lead to TN. Glossopharyngeal neuralgia can mean decreased heart function and eventual heart failure. Because the stress associated with chronic pain often leads to depression, there are many online and offline communities where neuralgia sufferers can get both information and support.
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