Neuralgia: what it is, signs and causes

The diagnosis of "neuralgia" means pain running along the course of a specific nerve, and behind this word lies a quite definite mechanism. Let us go through it in order: how an attack is structured, what causes it, and which signs distinguish nerve pain from dental or muscle pain.

What neuralgia is

Neuralgia is damage to peripheral nerves that produces attacks of pain in the area innervated by that nerve. The difference from neuritis is fundamental: in neuralgia there are no motor disturbances and no loss of sensation, and no structural changes are found in the nerve. The nerve "complains" but is not yet being destroyed.

There are two variants. In primary, or essential, neuralgia, examination reveals no other disease; in secondary, or symptomatic, neuralgia, the pain is caused by an inflammatory, tumorous, or other process acting on the nerve.

Nerves that pass through narrow canals and foramina are affected more often: there, any narrowing of the lumen affects the fiber. The most common type is trigeminal neuralgia; involvement of the occipital, glossopharyngeal, and other nerves is less common.

Postherpetic neuralgia is named separately — a more common type of nerve pain in an area previously affected by herpes zoster. Trigeminal neuralgia is also called tic douloureux.

Causes of neuralgia

In most cases the mechanism is the same — compression of the nerve. In trigeminal neuralgia, compression is usually created by a blood vessel pressing on the nerve inside the skull; the same nerve is damaged in multiple sclerosis or by a tumor, and then the pain is secondary.

Local triggers for damage to the trigeminal nerve are facial injuries, inflammation of the nasal sinuses, diseased teeth, and malocclusion. For neuralgias in general, trauma, infections, severe forms of colds, and exposure to cold are cited; in some cases the cause cannot be established.

A long course changes the picture: neuralgia passes into the neuritic stage, when structural changes appear in the nerve and loss of sensation is added.

Signs of neuralgia and the nature of the pain

Neuralgic pain is recognized by its pattern. It is paroxysmal: sharp, shooting, often described as an electric shock in the jaw, teeth, or gums. An attack lasts from a few seconds to about two minutes and stops as suddenly as it began.

In trigeminal neuralgia, the pain is usually unilateral and felt in the lower part of the face; bilateral involvement is rare, and the sides almost never hurt at the same time. In severe cases there can be hundreds of attacks a day, series last for days, weeks, and months, and remissions become shorter over time.

• an attack is triggered by a light touch: washing, eating, brushing teeth, talking;
• the trigger may be wind, even a light one, a stream of air from an air conditioner, or movement of the face or head;
• sometimes the pain arises without an obvious trigger;
• an attack is accompanied by redness of the skin, lacrimation, and local muscle spasms — a painful tic;
• before an attack, itching of the facial skin and a sensation of "pins and needles" are possible.

The geography depends on the nerve. Intercostal neuralgia causes pain in the rib area that intensifies with coughing and sneezing, often against a background of thoracic osteochondrosis. Occipital neuralgia is a throbbing pain from the back of the head to the temples and eyes, worse with head movements.

Over time, the attacks are joined by a constant aching, throbbing, or burning sensation. Living with such pain is hard: quality of life declines, and weight loss, isolation, and depression appear.

How neuralgia is diagnosed

There is no specific test, and this is the main difficulty. The doctor asks about the nature of the pain and rules out other conditions capable of producing similar sensations: there are many causes of facial pain. The diagnosis is not confirmed immediately — sometimes years pass from the first visits to clarity.

The landmarks are known: trigeminal neuralgia is considered rare, is more common in women, and usually begins at age 50–60; in people under 40 it is rare.

When pain requires a visit to a neurologist

The reason to seek help is frequent or persistent facial pain, especially if paracetamol and ibuprofen do not help and the dentist has ruled out dental causes. The doctor then assesses the symptoms and rules out other diseases.

Neuralgia by itself is not a reason to call an ambulance; 103 or 112 — if signs of a life-threatening condition, such as a stroke or heart attack, are added to the pain.

This material is for reference: it explains the mechanism and landmarks but does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer