What Types Of Neuralgia Are There?
The types of neuralgia are varied because this disorder is defined as pain that occurs in the distribution of a specific nerve, whose function is normal, that is, it is not altered. It is characteristic that it is intermittent, maximum at first and lancinating, similar to an electric shock or punctures.
It can be a single acute pain or several in a row. Its treatment is usually quite complex. This time we are going to review the types of neuralgia that exist.
Types of neuralgia according to its cause
Two types of neuralgia are distinguished if we are based on the cause behind the sign:
- Essential or idiopathic: these are those neuralgia where a lesion of the affected nerve, either peripheral or central, cannot be demonstrated. Despite clinical investigations, the painful condition cannot be justified.
- Secondary: when there is a local cause for the neuralgia.
Types of neuralgia according to the affected nerve
If we classify the types of neuralgia according to the nerve that is affected, we can distinguish two large areas of the body: the skull and the rest of the body. Among the cranial ones, perhaps the trigeminal is the best known, but there are others.
Cranial neuralgias
There are multiple nerves in the skull that can be affected by this stabbing pain. We describe the most relevant ones.
Trigeminal neuralgia
It is a rare disease that affects more women than men. Anyway, if we take neuralgia as a whole, it is one of the more prevalent in the older adult population. Despite this, it appears at any age.
It is characterized by brief and recurrent episodes of unilateral (one-sided) pain, resembling electric or stabbing shocks, in the distribution of one or more divisions of the fifth cranial nerve (called trigeminal ). It is triggered by simple stimuli, such as rubbing.
There are what are called activation or trigger zones , which when stimulated cause pain. Other triggers include chewing, talking, brushing teeth, cold air, smiling, or grimacing. In addition, patients may present with watery eyes, redness of the eye, and discharge from the nose.
The trigeminal nerve is located in the face, carrying the sensitivity of the face. It is also involved with the chewing muscles. It has three divisions or branches: ophthalmic, maxillary and mandibular. Pain can appear in one or more segments of the nerve. It usually lasts from several seconds to a few minutes, up to multiple times a day.
The cause of neuralgia is usually linked to a compression of the nerve at its root, in the vast majority of cases. But multiple myeloma, cerebellopontine angle and brainstem tumors have also been described as origins.
Glossopharyngeal neuralgia
It is characterized by a paroxysmal, intense and stabbing pain that affects the ear, the base of the tongue or below the angle of the jaw. It can be triggered by the action of chewing, swallowing, coughing, talking, yawning, certain tastes or touching the neck or external ear canal.
The duration of severe paroxysms is seconds to minutes, but there may also be a constant, dull, low-grade background pain. These episodes can repeat themselves up to a dozen times a day and even wake the patient up during the night. The evolution occurs with periods of weeks or months of intensity that alter with intervals of calm.
Occipital neuralgia
In this case, the pain is also brief, and can last from a few seconds to a few minutes. Its sensation is similar to an electric shock that follows the distribution of the peripheral or cranial nerves. It can be triggered by stimulation of trigger zones.
It is a cause of headache in the occipital region. It is described as a stabbing discomfort on one or both sides of the skull, at the back of the scalp, involving the distribution of the occipital nerve. Sometimes it is accompanied by decreased sensitivity in the affected area.
Injuries, such as whiplash during car accidents, can be a risk factor for occipital neuralgia. It is generally a one-sided condition.
Posthepetic neuralgia
Outside the skull, the chickenpox virus is the causative agent of herpes zoster or shingles, a rash by the reactivation of the pathogen. It persists for a period of years in the root ganglia of the cranial or spinal nerves, after the resolution of the original infection.
As immunity decreases with age or due to pathologies, it is transported along the peripheral nerves and produces neuralgia. Most cases of acute shingles are self-limited, although it causes significant distress, especially in older adults.
In turn, a variable percentage of patients may continue to experience pain for months or years after the resolution of the rash, in the condition known as postherpetic neuralgia. The nuisance is burning or stabbing and, in turn, constant or intermittent
There are three phases of pain associated with shingles:
- Acute: the pain precedes or accompanies the rash and can persist up to 30 days from its onset.
- Subacute: Here the pain persists beyond the healing of the rash, but resolves within four months of onset.
- Post-herpetic neuralgia: pain for more than four months from the onset of the rash.
Another type of neuralgia: of the intermediate nerve
Neuralgia of the intermediate nerve is a form in itself due to its characteristics. It consists of a brief, severe paroxysmal pain that is felt deep in the ear. It is a rare disorder.
In some people, an alteration of the perception of taste, such as the sensation of bitter taste, can occur, as well as disorders of lacrimation or salivation.
The challenge of diagnosing the different types of neuralgia
Generally speaking, the correct diagnosis of the different types of neuralgia can be quite difficult, since there are multiple causes that must be ruled out at a local and general level. Certainly, several specialized consultations will be required.
Together with the imaging studies it will be possible to orient yourself towards the possible etiologies. A careful study is essential, since it modifies the success of the treatment to be carried out.
