Cranial neuralgias are considered secondary headaches or headaches that are caused by an underlying condition. In this case, it is caused by an inflammation of the nerves in the upper part of the neck and the head. The nerves that are most susceptible to neuralgia are the trigeminal and glossopharyngeal nerves with the former causing pain in the areas of the eyes, cheeks and in the lower part of the face, and the latter can cause pain in the throat, tonsils, tongue and ears. Another common cranial nerve that can trigger an episode of neuralgia is the occipital nerve which causes chronic pain behind the eyes, at the back of the head, and in the upper part of the neck. The causes of the inflammation of these nerves are still unclear, but there are some serious conditions that can trigger nerve irritation which causes the pain we feel.
Diagnosis of Cranial Neuralgias
It is not uncommon for cranial neuralgias to be misdiagnosed, mostly because it can appear to be a different type of headache or condition depending on how a patient describes the pain to the doctor. Assessing neuralgia based on the symptoms patients report to their doctors can be difficult, which is why it is important to be able to describe the type, location, and severity of the pain, as well as how often the headaches occur and other symptoms that may occur alongside the headaches. This will help the doctor rule out other conditions and hone in on more probable causes. If the doctor suspects that the pain may be caused by neuralgia, a series of tests may be ordered to find out if the pain is indeed triggered by an inflamed cranial nerve. There will be nerve conduction studies, such as microneurography, wherein the peripheral nerve is stimulated and the reactions of the sensory portion of the nerve are recorded. Patients may also be asked to answer the McGill Pain Questionnaire to quantify the severity of the headaches for a more accurate diagnosis. Other tests doctors may need to perform to correctly diagnose cranial neuralgias include a skin biopsy and Quantitative Sensory Testing which studies the patient’s response to external stimuli.
There are three approaches to treating this condition. For most patients, doctors prescribe anticonvulsant medications to be taken in high doses to block nerve firing. Other medications that may be effective in treating neuralgias are tricyclic antidepressants. Some patients choose to combine drug treatment with alternative treatments and complementary techniques including osteopathy, acupuncture, massages and vitamin therapy just to name a few. These treatment plans are often effective; however, in cases where patients experience serious side effects because of the drugs or if the medication fails to relieve the pain, it is possible to treat the condition surgically. This surgical procedure is called neural augmentative surgery. This surgery entails placing electrodes in the dorsal root. The subcutaneous nerve is stimulated and in the process, the targeted nerve pathway is stimulated as well. This type of surgery carries a lot of risk and is used as a last resort in case drugs and alternative treatments don’t work.
While this condition is difficult to diagnose, once it is determined as the cause of the pain, it’s very important to get started on a course of treatment immediately.