Cranial Neuralgias

Abstract

This article describes the clinical findings of cranial neuralgias, such as trigeminal neuralgia, glossopharyngeal neuralgia, nervus intermedius neuralgia, and others, and postherpetic neuralgia. Pathophysiology of these neuralgias, diagnostic methods, and treatment are also discussed. This information will enable the dentist to diagnose patients who have these rare conditions.

Orofacial neuropathic pain

“…It occurs between 15 and 85 years of age, with mean age of 50 years, with equal distribution between genders 34 . It is an episodic unilateral pain in electric shock, shooting and severe.…”

“…Pain may be triggered by swallowing, yawning, speaking, chewing or something touching tonsils. Glossopharyngeal neuralgia (GN) may be followed by cardiovascular changes such as bradycardia, asystole, hypotension or syncope 34 . In general, most severe pain referred by patients is below jaw angle, and TP may be located close to external acoustic meatus 35,36 .…”

“…Intermediate nerve neuralgia, also known as geniculate neuralgia, is characterized as unilateral deep pain in electric shock, deeply located in the ear, with the presence of triggering-areas close to the posterior portion of the external acoustic meatus, but seldom involving the two anterior thirds of the tongue and soft palate 3,34 . It may be triggered by stimulation of external acoustic meatus, by talking or swallowing.…”

“…Treatment consists of physical medicine, triggering-zones infiltration, anticonvulsants and psychotropic drugs. In cases when conservative or minimally invasive therapies fail, open radiofrequency occipital nerve neurectomy or second cervical root rizhotomy might be indicated 14,34 .…”

Cranial Neuralgias, Sinus Headache, and Vestibular Migraine

“…Coexistence or overlap with other cranial nerve distributions should raise concern for an underlying CNS lesion. 17 …”