Suffering From Sharp Pain in Your Face And Neck? Doctor Explains The Reason
Neuralgia - a stabbing, severe pain that occurs along the damaged nerve and is most common in the face and neck. Dr Rajesh B Iyer, Senior Consultant Neurologist & Epileptologist, Manipal Hospitals Millers Road explains the reason.
Neuralgia refers to pain arising from the nerves. It is characterized by severe, shooting pain distributed across the territory of the affected nerve, which is often intermittent, occurring as bursts of sharp pain. Pain can occur spontaneously or be triggered by certain activities. Some nerves are more often affected. Neuralgia can be caused by infections like Herpes Zoster infection (postherpetic neuralgia [PHN]), nerve compression or irritation by bones, blood vessels, multiple sclerosis, or tumours. Metabolic conditions like diabetes can also lead to painful neuropathies. However, in many instances, the exact cause may not be detectable.
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Dr Rajesh B Iyer, Senior Consultant Neurologist & Epileptologist, Manipal Hospitals Millers Road explains everything about neuralgias.
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- Trigeminal Neuralgia (TN) is one of the commonest types of neuralgia and involves the fifth cranial nerve which carries facial sensation to the brain. Pain occurs on one side of the face, is often very severe, and may be triggered by sensory stimulation of the face like washing or touching the face, brushing teeth, chewing, etc.
In severe cases, even a gush of air may be a trigger. Specific causes include vascular loops compressing the nerve in its course, PHN, dental procedures. Diagnosis is based on the patient’s description of symptoms. An MRI scan done with specific protocols for vascular compression may be required in patients not responding to medical treatment.
Medications used for treating TN include medicines like Carbamazepine, Pregabalin, Gabapentin, Phenytoin, Baclofen, Amytiptelene, Lamotrigene, Topiramate, etc. The routine “painkillers” like paracetamol, ibuprofen, etc are ineffective. Patients with long-standing TN may have intermittent periods of flare-ups which can be treated with a combination of medications.
It is also important to avoid provoking factors like eating very hot or cold food, exposure to cold weather, and other identifiable triggers. Rarely do some patients experience acute excruciating pain which can be prolonged.
Recently, a 70-year-old gentleman presented with severe TN pain lasting more than a day and was unable to eat or drink. He was treated with Injection fosphenytoin with which his pain resolved in an hour! TN due to PHN generally resolves completely whereas those due to vascular compression or unknown causes tend to persist.
If pain is unresponsive to medications, other options can be considered, namely radiofrequency ablation of the trigeminal nerve, radiation therapy, or microvascular decompression surgery of the nerve.
- Glossopharyngeal neuralgia (GN) is characterized by a sharp, jabbing pain deep in the throat, ear canal, inner part of the tongue, tonsil, or below the angle of the jaw. Pain typically lasts a few seconds to minutes. Swallowing is the most common trigger factor, often with cold liquids.
Chewing, talking, sneezing, clearing the throat, touching the oral mucosa, ears, and neck, sudden movements of the head or jaw can trigger pain. The cause is unknown in most patients but can occur with certain tumors, multiple sclerosis, vascular malformations. Compression can be caused by an elongated bone called the styloid process (Eagle’s syndrome) or a calcified stylohyoid ligament.
- Occipital neuralgia is sudden, severe pain that occurs on the backside of the head and is often mistaken for migraine. The pain is usually intense, piercing, stabbing, and sharp, lasting a few minutes but the region may be tender subsequently.
- Intercostal neuralgia affects the intercostal nerves that run below the ribs. It occurs commonly after Herpes zoster and can also occur after injuries, surgeries, and compression of the nerves. Chest movements like deep breathing, coughing, sneezing or laughing, and lying on one side can trigger the pain.
- Post Herpetic Neuralgia occurs after Herpes zoster (shingles) and can be very intense. It may last a few months and rarely persist for a long duration of time.
- Meralgia Paresthetica refers to neuropathic symptoms affecting the lateral cutaneous nerve on the outer aspect of the thighs.
- Diabetic peripheral neuropathy (DPN) can at times be very painful. Apart from symptomatic measures for neuropathy, strict control of blood sugar and ensuring adequate arterial blood supply to limbs is important in managing DPN
Medical management of most of these neuralgias is similar to that of TN. In addition, local anesthetic injections, nerve blocks, or surgical interventions can also help in some instances depending on the location and cause.
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