Facial or cranial neuralgias are often referred to as pain associated with a specific distribution of a cranial nerve. Depending on the nerve involved we identify occipital neuralgia, trigeminal neuralgia, glossopharyngeal neuralgia, etc.
Neuralgias and Facial Pain
There are multiple causes of neuralgias depending on specific neuralgia type. Some neuralgias could be a symptom of another underlying condition or may result from compression of the particular nerve by a blood vessel or other structures. Irritation and inflammation of the nerve caused by severe muscle tightness or whiplash injury can sometimes be the cause of occipital neuralgia. In some cases, we are not able to pinpoint a specific mechanism that is causing the pain.
Depending on a particular nerve distribution patient may experience pain in the forehead or above one of the eyes, middle of the face (sinuses area), teeth, throat, or in the back of the head or upper neck. Patients frequently describe neuralgia associated pain as being sharp and lancinating. Each painful attack may last only for a few seconds but it may occur up to 20 or even 100 times per day. Many patients may notice so-called “trigger zones” activation of which may trigger an attack. Other patients may notice that certain activities (such as swallowing or drinking) or movement of the neck or head may immediately trigger the pain.
Depending on neuralgia type we may suggest patients start taking neuromodulating type medications such as certain antiseizure drugs that alter the way nerve cells communicate with each other in a way that may help reduce the pain. Some patients may benefit from a certain type of antidepressants that have been proven to be effective in pain management. We may suggest adding a muscle relaxant and physical therapy to manage certain types of neuralgias. Depending on the clinical presentation patient may also benefit from an interventional pain procedure that may involve a nerve block or a trigger point injection. In certain cases, neurosurgical evaluation and treatment may be recommended.
Persistent Idiopathic Facial Pain
Persistent idiopathic facial pain (also known as atypical facial pain or persistent facial pain of unknown cause) is a condition that presents with pain in the face area that does not meet established and recognized diagnostic criteria and when the source of the pain cannot be identified.
As the name suggests the source or cause of the pain remains unknown.
Presentation of persistent idiopathic facial pain varies from patient to patient. Most of the patients described pain located on one side of the face. Patients may describe the pain as sharp or dull, aching or burning, throbbing, or pulsating. The pain could be intermittent or constant.
Diagnosis of persistent idiopathic facial pain can be challenging and appears to be a diagnosis of exclusion. Clinical history and thorough physical and neurological examinations are important. We frequently order blood tests and neuroimaging modalities of the head and neck such as MRI, MRA, and/or MRV. Occasionally, additional evaluations by other specialists such as neurologists, dentists/orthodontists or ear nose and throat specialist may be necessary.
Treatment depends on a specific clinical presentation. We may use corticosteroids and nonsteroidal anti-inflammatory medications, neuromodulators, certain antidepressants. Some patients may benefit from a series of sphenopalatine ganglion blocks (SPG blocks) or other peripheral nerve blocks.
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