What types of neuralgia are there?


Neuralgia is an annoying and recurrent pain that complicates the quality of life of people who suffer from it. Here are the usual classifications used to catalogue this discomfort.

neuralgia causes

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, ie not altered. It is characteristic that it is intermittent, maximum at the beginning and lancinante, similar to an electrical discharge or to punctures.

It can be a single acute pain or several in a row. Its treatment is usually quite complex. In this opportunity, we will review the types of neuralgia that exist.

Types of neuralgia according to their cause

Two types of neuralgia are distinguished if we base ourselves on the cause that is hidden behind the sign:

Essential or idiopathic: these are those neuralgias where no injury to the affected nerve can be demonstrated, whether peripheral or central. Despite clinical research, the painful picture cannot be justified.

Secondary: when there is a local cause for the occurrence of neuralgia.

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 body areas: the skull and the rest of the body. Among the cranial ones, perhaps one of the trigeminal is the most well-known, but others exist.

neuralgia meaning

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 more women than men. In any case, if we take into account all the neuralgias, it is one of the most prevalent in the older adult population. Despite this, it appears at any age.

It is characterized by short, recurrent episodes of unilateral (one-sided) pain, similar to electric or stabbing shocks, in the distribution of one or more divisions of the fifth cranial nerve (called the trigeminal). It is triggered by simple stimuli, such as friction.

There are what are called trigger zones, which when stimulated cause pain. Other triggers include chewing, talking, brushing teeth, cold air, smiling, or grimacing. In addition, patients may experience tearing, redness of the eye, and discharge from the nose.

The trigeminal nerve is found in the face, carrying the sensitivity of the face. It is also involved with the muscles of mastication. 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, even 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. However, tumors of the cerebellopontine angle and the brain stem have also been described as the origin of multiple myeloma.

Glossopharyngeal Neuralgia

It is characterized by a paroxysmal, intense, stabbing pain that affects the ear, the base of the tongue, or under 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 ear canal.

The duration of severe paroxysms is from seconds to minutes, but there can also be a background pain, dull and constant, of low degree. These episodes can be repeated up to a dozen times a day and even wake the patient up during the night. The evolution occurs with periods of weeks or months of intensity that alter 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 electrical discharge that follows the distribution of the peripheral or cranial nerves. It can be triggered by the stimulation of trigger zones.

It is a cause of headaches in the occipital region. It is described as a throbbing discomfort on one or both sides of the skull, at the back of the scalp, involving the distribution of the occipital nerve. It is sometimes accompanied by decreased sensation in the affected area.

Injuries, such as whiplash during car accidents, can be a risk factor for occipital neuralgia. It is usually a condition that produces one-sided symptoms.

Postherpetic Neuralgia

Outside the skull, the chickenpox virus is the causal agent of herpes zoster or shingles, a rash caused by the reactivation of the pathogen. It persists for a period of years in the cranial or spinal nerve root ganglia after the resolution of the original infection.

As immunity decreases with age or due to pathologies, it is transported along the 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 varying percentage of patients may continue to experience pain for months or years after resolution of the rash, in the condition known as postherpetic neuralgia. The discomfort is burning or throbbing and, in turn, 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

The neuralgia of the intermediate nerve is a form in itself by its characteristics. It consists of a severe and brief paroxysmal pain felt deep in the ear. It is a rare disorder.

In some people, there may be an alteration in the perception of taste, such as a bitter taste sensation, as well as tearing or salivation disorders.

neuralgia symptoms

The challenge of diagnosing different types of neuralgia

In general, the correct diagnosis of the different types of neuralgia can be quite difficult, since there are multiple causes that should be ruled out locally and generally. Certainly, it will require several specialized consultations.

Together with the imaging studies, it will be possible to focus on possible etiologies. A thorough study is essential, as it changes the success of the treatment to be performed.