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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Neuralgia

The trigeminal nerve has three distinct branches. Neuralgia in any one of them produces pain within the regions indicated.

What is it?

Neuralgia refers to a range of disorders marked by spasms of pain along the path of a nerve. Neuralgia tends to afflict people over age 50. Some forms are named for the nerves they affect. For example, trigeminal neuralgia, also known as tic douloureux, affects the trigeminal (fifth cranial) nerve that supplies sensation to the face, causing brief but intense spasms of pain on one side of the lips, gums, cheek, chin, or, rarely, around the eyes.Other forms of neuralgia are associated with specific diseases. Post-herpetic neuralgia can arise after a case of shingles; it causes a dull, burning pain that may persist for months or even years. Facial neuralgia may also be a feature of multiple sclerosis or migraines. Trigeminal neuralgia is fairly common, particularly in older women; postherpetic neuralgia is also common, while the other forms of neuralgia are rare. Although painful, neuralgia is not life-threatening.

What Causes It?

  • In most cases the cause is unknown.
  • Some cases may be due to compression of the nerve by blood vessels or a tumor.
  • Herpes zoster infection (shingles) precedes postherpetic neuralgia.
  • Multiple sclerosis is a cause of neuralgia in those younger than 50.

Prevention

  • There are no known ways to prevent neuralgia.

Diagnosis

  • Neuralgia is identified by symptom presence.
  • X-rays or MRI (magnetic resonance imaging) may be done to rule out other conditions.

How to Treat It

  • Over-the-counter pain relievers may help. The most effective prescription medications are nortriptyline, amitriptyline, gabapentin, and carbamazepine.
  • A topical cream containing capsaicin (such as Zostrix or Axsain), along with physical therapy, may ease postherpetic neuralgia.
  • More invasive procedures may be warranted if drug treatment fails. The most common approach delivers high-frequency sound waves or electrical currents to the nerve to reduce its sensitivity. This often helps but causes lingering numbness and, if the region around the eye is involved, may result in corneal damage. Also, neuralgia may recur.
  • Another approach involves exploratory surgery to look for and loosen any blood vessels that may be compressing the nerve. This approach provides longterm relief in most cases but can require up to a week of hospitalization and, like all major surgeries, carries significant risks.

When to Call a Doctor

  • Call a doctor if you experience persistent pain that does not respond to over-the-counter treatment.