NEURALGIA

cyclic attacks of acute pain occurring in the distribution of a peripheral sensory nerve; the cause of the pain is unknown, and pathological changes in nerve tissue cannot be found. Neuralgia is frequently confused with another disorder, neuritis, but the terms are not synonymous. There are two principal types of neuralgia: trigeminal neuralgia (tic douloureux) and glossopharyngeal neuralgia. Trigeminal neuralgia is a complex of symptoms of unknown cause characterized principally by brief attacks of severe pain along any of the branches of the trigeminal nerve (lying on the skull in front of the ear). The disease may occur at any age after puberty but usually begins somewhat after middle age. It affects women more frequently than men. The intense pain is usually described by patients as stabbing, shooting, or lightning-like and extremely brief. In early stages of the disease, these pains last for less than a minute or two, with weeks or months between attacks. As the condition progresses, the periods between attacks become shorter. Areas around the nose and mouth become hypersensitive and, when touched, trigger an attack. Attacks are also touched off by talking, eating, drinking, or exposure to cold. Analgesics offer temporary relief. The condition can be cured permanently by severing the sensory root of the nerve proximal to the ganglion. Simple decompression of the roots and of the posterior part of the ganglion have had some good results. Glossopharyngeal neuralgia is a relatively rare disorder characterized by recurring severe pain in the pharynx, tonsils, back of the tongue, and middle ear. The cause is unknown, and the disease usually has its onset after age 40, more frequently in males than in females. The pains may be excruciating, beginning in the throat and radiating to the ears or down the side of the neck. They may occur spontaneously or be triggered by sneezing, coughing, yawning, chewing, or talking. The attacks are usually separated by long intervals and, when they do occur, last only a few seconds to a minute or two. Medical treatment is usually ineffective, for the attack subsides before analgesics exert their action. Surgery is indicated in extreme cases. See also neuritis.