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Marshall James Nev, PLC | Neuralgia - A Most Painful Condition in Richmond

Lexington-Richmond Headache Clinic
Marshall James Ney, DMD, FAAOP
Fellow American Academy of Oral Facial Pain

527 W. Main St.
Richmond, 40475
(859) 623-3761

Neuralgia - A Most Painful Condition


Neuralgia is pain in the nerve itself. The pain is described as burning or electric like. In the head and neck it usually comes on quickly and leaves quickly. Neuralgia is not near as common as headaches caused by muscle or blood vessels.

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A neuralgia is a pain in one or more nerves. The pain is not continuous but is very, very severe. Patients describe it as a stabbing , burning, electric-like pain. There are several kinds of neuralgias, and each is named after the nerve involved:

  1. Trigeminal Neuralgia is the most common head and neck neuralgia. It is named after the 5th or trigeminal nerve. Do it: Read more about its causes and treatment below.
  2. Glossopharangeal Neuralgia is triggered by the nerve located in the throat just in front of the tonsils
  3. Nerve Intermedius Neuralgia occurs in the nerve inside the ear canal. Disorders of taste and salivation may also be present.
  4. Superior Laryngeal Neuralgia is felt deep in the throat near the voice box.
  5. Idiopathic Neuropathic Pain is similar to trigeminal neuralgia, but instead of being episodic, it is continous.

Trigeminal Neuralgia

“Tic douloureux”

neuralgia1.png neuralgia2.png

Trigeminal neuralgia is perhaps the most painful condition you can have. It is, however, very predictable to treat.

The above drawings show the distribution of the fifth cranial or trigeminal nerve. The first branch of the trigeminal nerve goes to the forehead and up about to the vertex of the skull.

The second branch goes to the upper jaw or maxilla. The most common branch for trigeminal neuralgia is the 2nd or maxillary branch.

The third branch goes to the mandible (lower jaw) and also goes to the same blood vessels that cause migraines.

But how, exactly, does the pain occur in trigeminal neuralgia?

Recall that we like to talk about pain in terms of how it feels to you, the patient.

  1. Vascular pain, the pain you feel in a migraine, has a fast throbbing that matches the beat of your heart.
  2. Muscle pain is a steady, constant, or slowly throbbing pain.
  3. Neuralgia pain, or nerve pain caused by a problem with the nerve itself burns or has an electric-like quality.

The most common neuralgia, trigeminal neuralgia, comes on suddenly and without warning. Patients sometimes say that this pain is like getting hit in the face with a cattle prod!

Causes of Trigeminal Neuralgia

While much of the time there is no apparent cause, there are some instances which can cause this neuralgia:

  1. A tooth abscess.
  2. Facial or oral surgery. It is not that someone did anything wrong, but that the pain begins after the oral surgery.
  3. Accident in which you have facial injuries.
  4. Multiple Sclerosis.

When we are not able to identify any other cause, you may hear the word “idiopathic”. This just means “doctor does no know”!

Diagnosis and Treatment

  1. The diagnosis is made from the patient’s description of the pain and the sudden onset of the pain and then the quick exodus of excruciating pain. The trigger for the pain can be chewing. Even the light touch of a finger or the gentle breeze of a fan can set it off.
  2. Diagnostic blocks use local anesthesia such as Marcaine which numb the branch of the nerve that the neuralgia is in. If the neuralgia is in that branch, the pain should go away with this local anesthesia.
  3. The pain can be resolved using anti-seizure medication such as carbamazepine, gabapentin, lamotrigine, phenytoin, valproate, and pregabalin. (Sorry about the big words!)

    While these medications may make the patient feel better, they have many side effects, so our usual recommendation is for a “thermal rhizotomy.” This is done by a neurosurgeon in an out-patient setting. The pain relief is usually very good. Some numbness may result, but Dr. Ney has never seen a problem with motor control (movement of muscles) result from this procedure. On the average, the pain relief lasts for 10 years.


Richmond Dentist | Neuralgia - A Most Painful Condition. Marshall James Ney is a Richmond Dentist.