other disorders discussed here include a variety of cranio-facial pain
disorders or cephalic neuralgias. They are often named according to
the nerve responsible for the pain. Examples discussed in this section
are Cluster Headache
(also known as Petrosal Neuralgia or Migrainous Neuralgia), Geniculate
Neuralgia (Sluder's Neuralgia), Paratrigeminal
Neuralgia of Raeder and Occipital
Neuralgia. Other facial pain disorders include Anesthesia
Dolorosa and Atypical
headache is characterized by severe pain on one side of the face in
the frontal and/or eye (retro-orbital) regions. The pain, described
as stabbing or shooting, lasts anywhere from a few minutes to hours,
and may awake the sufferer from sleep. These attacks are usually "clustered"
over several days to weeks and are followed by remissions lasting weeks
the majority of sufferers medical therapy is the most effective treatment
for Cluster Headache. The mainstay of medical treatments include methysergid,
Ergotamine, Verapamil, Flunarizine, Valproic acid, and Lithium carbonate.
Corticosteroids (including Prednisone) can also control cluster headache,
and generally take affect within a few days. Treatment of newly diagnosed
cluster headache may be initiated with a prescription of subcutaneous
Sumatriptine. Oxygen may also be used to control acute attacks of pain,
and is effective in two-thirds of sufferers.
Geniculate Neuralgia (GN), also called nervus intermedius neuralgia, is a rare disorder that involves severe pain deep in the ear, that may spread to the ear canal, outer ear, mastoid or eye regions. GN may also occur in combination with trigeminal or glossopharyngeal neuralgia.
The pain of GN is sharp, shooting or burning and can last for hours. Painful attacks can be triggered by cold, noise, swallowing or touch, but triggers are usually very unique to the sufferer. Other related symptoms that may be experienced include increased salivation, bitter taste, tinnitus and vertigo. This disorder usually occurs in young to middle-aged adults, and more commonly in women.
Geniculate Neuralgia may be caused by neurovascular compression of the fifth, ninth and/or tenth cranial nerves. In sufferers of GN, signals sent along these nerves are altered and interpreted by the geniculate ganglion (a structure in the brain) as GN pain. GN may also develop following herpes zoster oticus (Ramsey Hunt syndrome), where cold sores occur on the ear drum or ear. This may also be associated with facial paresis (weakness), tinnitus, vertigo and deafness.
Treatments: GN usually cannot be treated with medications. A variety of surgeries have been performed including microvascular decompression of the fifth, ninth, and tenth nerves, as well as partial cutting of the nervus intermedius, geniculate ganglion, chorda tympani and/or the ninth and tenth cranial nerves.
Also known as Sluder's neuralgia, this facial pain disorder is characterized by unilateral headache behind the eyes with pain in the upper jaw or soft palate, with occasional aching in the back of the nose, the teeth, the temple, the occiput, or the neck. The pain is associated with nasal and/or sinus congestion, swelling or redness of nasal mucous membranes, tearing and redness of the face. Sphenopalatine neuralgia must be distinguished from cluster headache, although both are characterized by similar symptoms. Sluder's neuralgia, however, involves pain that is longer in duration, with inflamed nasal mucosa on the involved side. This disorder is more common in women (2:1, women to men) and appears to be caused by an irritation of the sphenopalatine ganglion from intranasal infection, deformity or scarring.
Treatment: Medical therapy for sinus decongestion can alleviate symptoms. Ganglion blocks are also effective for pain control, either by intranasal application or direct injection. The underlying cause of Sluder's neuralgia can also be targeted if apparent.
Paratrigeminal Neuralgia of Raeder
syndrome consists of headaches in the upper face associated with eye
and skin changes (oculosympathetic palsy) on one side of the face. The
pain is described as intense or throbbing, and there may also be drooping
of the eyelid and contraction of the pupil (miosis). Symptoms are frequent
in the morning, and attacks can last between a few days and a few weeks.
Some sufferers experience an unpleasant taste (dysageusia), possibly
due to involvement the chorda tympani (a branch of the VII cranial
Following injury to the trigeminal nerve, a painful area of numbness may develop that is diagnosed as anesthesia dolorosa. This pain is severe and constant and described as burning, gnawing, or stinging. The most common cause is from destructive interventions for trigeminal neuralgia.
Treatments: Treatment of anesthesia dolorosa is often ineffective, and medications will often not relieve the pain. Surgical interventions that have been tried with limited success include focused injury to the brain stem (tractotomy of the nucleus caudalis), deep brain stimulation and pre-motor cortex stimulation. In general, additional destructive interventions are not effective.
facial pain (or idiopathic facial pain) is characterized by deep, achy,
constant, pulling or crushing pain that involves diffuse areas of the
face and head. The pain fluctuates in intensity and severity. Trigger
points on the face cannot be found, the pain is often worse at night,
and may be aggravated by activity.
Treatments: Unfortunately, atypical facial pain is typically difficult to treat, and surgery is generally avoided. While radiofrequency rhizotomy has been performed, such destructive interventions may actually worsen the pain. Tricyclic antidepressant medications can provide sufferers with modest relief of their symptoms. Conventional analgesic drugs, including opioids, can also be effective in selected individuals, often under the direction of a comprehensive pain management program.
neuralgia is characterized by jabbing pain radiating from the neck to
the back of the head on one side (distributions of the occipital nerve).
The pain may also radiate to the forehead and eye, and there is usually
some nerve tenderness and numbness in the affected area. There may be
a continuous aching or throbbing pain upon which jabbing pains are superimposed.
Attacks can be intensified or provoked by physical or emotional stress.
or Neurontin can reduce occipital neuralgia pain. Injections of local
anesthetic (diagnostic blocks) may temporarily relieve occipital neuralgia.
Repeated injections can be combined with steroids for longer lasting
pain control in some individuals.
Disorders of the vestibular cochlear nerve (VIII) can result in tinnitus (ringing noise in the ear), vertigo (sensation of spinning), dizziness, nausea or hearing loss. There are many possible causes for these various symptoms, which are generally investigated by specialists in Otolaryngology. In rare instances, neurovascular compression involving the vestibular cochlear nerve may be implicated as the cause of such symptoms. In such cases,microvascular decompression surgery has been performed to cure patients of these symptoms.