Cranial Neuralgias

Pain arising from cranial neuralgias represents a significant health burden. Successful treatment depends on accurate diagnosis, which requires knowledge of neuroanatomy and pathophysiology as well as familiarity with the varied clinical presentations encountered in neurologic practice. This article delineates the relevant anatomy, clinical features, and management of the most common primary and secondary cranial neuralgias.

Trigeminal neuralgia, which can result from neurovascular compression or demyelination, is a particularly severe form of facial pain. Herpes zoster virus is a common cause of neuralgia that causes herpes zoster ophthalmicus acutely and postherpetic neuralgia chronically. Rarer facial pain syndromes arising from a single nerve include glossopharyngeal neuralgia, nervus intermedius neuralgia, and paratrigeminal oculosympathetic syndrome.

In patients presenting with a cranial neuralgia, unless the etiology is apparent (eg, herpes zoster), cranial imaging studies should be undertaken to look for structural abnormalities such as neoplasm, granulomatous disease, demyelinating disease, or vascular malformations. Management of both common and rare cranial neuralgias is often challenging and is best guided by the most recent available evidence.