Pressure on nerves by nearby bones, ligaments, blood vessels, or tumors
Trauma (including surgery)
In many cases, the cause is unknown.
Postherpetic neuralgia and trigeminal neuralgia are the two most common forms of neuralgia. A related but less common neuralgia affects the glossopharyngeal nerve, which provides feeling to the throat.
Neuralgia is more common in elderly people, but it may occur at any age.
Increased sensitivity of the skin along the path of the damaged nerve, so that any touch or pressure is felt as pain
Numbness along the path of the nerve
In the same location each episode
May come and go (intermittent), or be constant, burning pain
May get worse when the area is moved
Weakness or complete paralysis of muscles supplied by the same nerve
Signs and tests
The health care provider will take a complete history, including:
When the pain started
Any potentially related medical problems
Any recent injuries or changes in health
An examination may show:
Abnormal sensation in the skin
Loss of deep tendon reflexes
Loss of muscle mass
Lack of sweating (sweating is controlled by nerves)
Tenderness along a nerve, often in the lower face and jaw and rarely in the temple and forehead
Trigger points (areas where even a slight touch triggers pain)
A dental examination can rule out dental disorders that may cause facial pain (such as a tooth abscess). Other symptoms (such as redness or swelling) may help rule out conditions such as infections, bone fractures, or rheumatoid arthritis.
There are no specific tests for neuralgia, but the following tests may be done to find the cause of the pain:
Blood tests to check blood sugar, kidney function, and other possible causes of neuralgia
The goal of treatment is to reverse or control the cause of the nerve problem (if found), and provide pain relief. Treatment varies depending on the cause, location, and severity of the pain, and other factors. Even if the cause of the neuralgia is never found, the condition may improve on its own or disappear with time.
Surgery to remove pressure on the nerve from nearby bones, ligaments, blood vessels, or tumors may be needed.
Strict control of blood sugar may speed recovery in people with diabetes who develop neuralgia.
Medications to control pain may include:
Antidepressant medications (amitriptyline, nortriptyline, or duloxetine)
Antiseizure medications (carbamazepine, gabapentin, lamotrigine, phenytoin, or pregabalin)
Mild over-the-counter analgesics (aspirin, acetaminophen, or ibuprofen)
Narcotic analgesics (codeine) for short-term relief of severe pain (however, these do not always work well)
Topical creams containing capsaicin
Other treatments may include:
Local injections of pain-relieving (anesthetic) drugs
Physical therapy (may be needed for some types of neuralgia, especially postherpetic neuralgia)
Procedures (such as nerve ablation using radiofrequency, heat, balloon compression, or injection of chemicals) to reduce feeling in the nerve
Unfortunately, these procedures may not improve symptoms and can cause loss of feeling or abnormal sensations.
When other treatment methods fail, doctors may try motor cortex stimulation (MCS). An electrode is placed over part of the brain and is hooked to a pulse generator under the skin.
Most neuralgias are not life-threatening and are not signs of other life-threatening disorders. However, pain can be severe. For severe pain that does not improve, see a pain specialist so that you can explore all treatment options.
Most neuralgias will respond to treatment. Attacks of pain usually come and go. However, attacks may become more frequent in some patients as they get older.
Complications of surgery
Disability caused by pain
Side effects of medications used to control pain
Unnecessary dental procedures before neuralgia is diagnosed
Calling your health care provider
Contact your health care provider if:
You develop shingles
You have symptoms of neuralgia, especially if over-the-counter pain medications do not relieve your pain
You have severe pain (see a pain specialist)
Treating related disorders such as diabetes and renal insufficiency may prevent some neuralgias. Strict control of blood sugar may prevent nerve damage in people with diabetes. In the case of shingles, there is some evidence that antiviral drugs and a herpes zoster virus vaccine can prevent neuralgia.
Cutrer FM, Moskowitz MA. Headaches and other head pain. In: In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 421.
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Daniel B Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.