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 the beginning and lancinating, similar to an electric shock or punctures.
It may be a single sharp pain or several in a row. Its treatment is usually quite complex. On this occasion we are going to review the types of neuralgia that exist.
Two types of neuralgia are distinguished if we base ourselves on the cause behind the sign:
Essential or idiopathic: these are those neuralgias where an injury to the affected nerve cannot be demonstrated, whether peripheral or central. Despite clinical investigations, the painful condition cannot be justified.
Secondary: when there is a local cause for which the neuralgia occurs.
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 one is the best known, but there are others.
Trigeminal neuralgia is the best known, but there are many others.
Cranial neuralgia
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 women more than men. In any case, if we take neuralgia as a whole, it is one of the most prevalent in the older adult population. Despite this, it appears.
It is characterized by brief, recurrent episodes of unilateral (one-sided) pain, resembling electric shocks or stabbing, 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. Additionally, patients may experience tearing, redness of the eye, and discharge from the nose.
The trigeminal nerve is located in the face, carrying sensation to the face. It is also involved with the muscles of chewing. It has three divisions or branches: ophthalmic, maxillary and mandibular. Pain may 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 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 paroxysmal, intense, 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 dull, constant, low-grade background pain. These episodes can repeat up to a dozen times a day and even wake the patient during the night. The evolution occurs with periods of weeks or months of intensity that alternate with intervals of calm.
Occipital neuralgia
In this case, the pain is also brief, lasting 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, in 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, may be a risk factor for occipital neuralgia. It is usually a condition that produces one-sided symptoms.
Posthepertic neuralgia
Outside the skull, the chickenpox virus is the causative agent of herpes zoster or shingles, a rash caused by the reactivation of the pathogen. It persists for a period of years in the root ganglia of cranial or spinal nerves, after resolution of the original infection.
As immunity declines with age or pathology, it is transported along peripheral nerves and produces neuralgia. Most cases of acute shingles are self-limiting, although it causes significant suffering, especially in older adults.
In turn, a variable percentage of patients may continue to experience pain for months or years after the rash resolves, in the condition known as postherpetic neuralgia. The discomfort is burning or stabbing and, at the same time, constant or intermittent
There are three phases of pain associated with shingles:
- Acute: the pain precedes or accompanies the rash and can persist for 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.
- Postherpetic 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 constitutes a form in itself due to its characteristics. It consists of a severe and brief paroxysmal pain felt deep in the ear. It is a rare disorder.
In some people, altered taste perception may occur, such as a sensation of bitter taste, as well as tearing or salivation disorders.
The challenge of diagnosing the different types of neuralgia
In general terms, 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 imaging studies it will be possible to orient ourselves towards possible etiologies. A thorough study is essential, since it modifies the success of the treatment to be performed.
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