Chronic Facial Pain and Other Chronic Neuralgias

Abstract

Neuralgia is defined as pain in the distribution of a specific nerve(s). Cranial neuralgias are characterized by craniofacial pain of varying character and distribution and are usually associated with, at least, some neurologic symptoms/deficits. Trigeminal neuralgia is the most common and the most severe of all cranial neuralgias and is characterized by recurrent attacks of pain in the distribution of one or more divisions of the trigeminal nerve. Glossopharyngeal neuralgia is defined as recurrent paroxysms of pain in the distribution of the auricular and pharyngeal branches of the vagus nerve as well as branches of the glossopharyngeal nerve and can rarely be associated with vagal symptoms, particularly syncope and/or bradycardia. Nervus intermedius neuralgia is characterized by brief paroxysms of unilateral pain in the auditory canal which can sometimes radiate to the parieto-occipital region. Occipital neuralgia is characterized by paroxysmal stabbing pain in the distribution of the greater, lesser, and/or third occipital nerves. Optic neuritis is an acute demyelinating condition characterized by retro-orbital pain with associated impairment of central vision. Headache attributed to ischemic ocular nerve palsy is characterized by unilateral frontal and/or periorbital pain caused by ischemic paresis of the ipsilateral third, fourth, or sixth cranial nerves. Recurrent painful ophthalmoplegic neuropathy is characterized by recurrent attacks of paresis of one or more ocular cranial nerves, with associated ipsilateral headache. Tolosa-Hunt syndrome consists of unilateral orbital pain associated with ophthalmoplegia and is caused by a granulomatous inflammation in the cavernous sinus, superior orbital fissure, or orbit. Paratrigeminal oculosympathetic syndrome is characterized by constant, unilateral pain in the distribution of the ophthalmic division of the trigeminal nerve, along with ipsilateral Horner’s syndrome, and is commonly caused by lesions involving the middle cranial fossa or the carotid artery. Burning mouth syndrome consists of recurrent intraoral burning sensation without clinically evident causative lesions. Persistent idiopathic facial pain is defined as persistent and recurrent facial and/or oral pain in the absence of clinical neurological deficit. Central neuropathic pain is a craniocervical pain syndrome of variable presentation caused by a demyelinating lesion in the central nervous system or an ischemic or hemorrhagic stroke.