ConditionBrain & nerves
Neuralgia (Nerve Pain)
Neuralgia is pain that follows the path of a nerve, often described as sharp, stabbing, shooting, electric or burning. It happens when a nerve is irritated, compressed or damaged. Common types include trigeminal neuralgia in the face, postherpetic neuralgia after shingles, and occipital neuralgia at the back of the head. Neuralgia pain usually responds poorly to standard painkillers but often improves with nerve pain medicines such as carbamazepine, gabapentin or amitriptyline, nerve blocks, or procedures to relieve pressure on the nerve.
Also called: Nerve pain, neuropathic pain, shooting nerve pain
At a glance
- What it is
- Pain along the course of a nerve from irritation or damage.
- Common types
- Trigeminal, postherpetic, occipital, glossopharyngeal, intercostal neuralgia.
- Typical pain
- Sharp, shooting, electric, burning, sometimes triggered by light touch.
- Causes
- Nerve compression, shingles, diabetes, MS, injury, surgery, infections.
- Treatment
- Anticonvulsant and antidepressant nerve pain medicines, topical treatments, nerve blocks, surgery.
When to get help
Call 911 or go to the ER
- Sudden severe face pain with weakness, facial droop, speech difficulty or vision loss
- New nerve pain with weakness in the legs, numbness around the genitals or loss of bladder or bowel control
See a doctor within a day or two
- A band of burning or tingling pain on one side of the body, followed by a rash (possible shingles; antivirals work best within 72 hours)
- Shingles near the eye or on the tip of the nose
- Nerve pain with fever, unexplained weight loss or a history of cancer
Book a routine appointment
- Repeated bursts of electric-shock face pain triggered by chewing, talking or touching the face
- Persistent burning pain after shingles has healed
- Shooting pain at the back of the head or along the ribs that keeps recurring
What neuralgia feels like
- sudden, brief bursts of sharp, stabbing or electric shock-like pain
- constant burning, aching or throbbing in some types
- pain triggered by light touch, wind, chewing or temperature (allodynia)
- numbness, tingling or increased sensitivity in the same area
- pain confined to the territory of one nerve
Types of neuralgia
| Type | Nerve and location | Features |
|---|---|---|
| Trigeminal neuralgia | Trigeminal nerve; cheek, jaw, lips, gums, forehead | Seconds-long electric shocks on one side of the face, triggered by eating, talking, brushing teeth or a breeze |
| Postherpetic neuralgia | Any nerve affected by shingles | Burning, aching, itching pain lasting 3 months or more after the rash |
| Occipital neuralgia | Occipital nerves; back of head and scalp | Shooting pain from the base of the skull over the scalp, scalp tenderness |
| Glossopharyngeal neuralgia | Glossopharyngeal nerve; throat, tonsil area, ear | Stabbing pain triggered by swallowing, coughing or yawning |
| Intercostal neuralgia | Intercostal nerves; ribs and chest wall | Band-like pain around the chest, often after surgery, injury or shingles |
| Pudendal neuralgia | Pudendal nerve; genitals, perineum | Pain worse sitting. See pudendal nerve injury |
| Sciatica | Sciatic nerve roots; buttock and leg | Shooting leg pain from a pinched nerve in the lower back |
Causes
- compression of a nerve, for example by a blood vessel pressing on the trigeminal nerve, a herniated disc, or tight muscles
- shingles (reactivated chickenpox virus)
- diabetes and other causes of peripheral neuropathy
- multiple sclerosis, a cause of trigeminal neuralgia in younger people
- injury or surgery affecting nerves
- tumors pressing on nerves (rare)
- infections such as Lyme disease or HIV
- chemotherapy and some other medicines
Risk increases with age, particularly for trigeminal and postherpetic neuralgia.
Diagnosis
Diagnosis rests on the description of the pain, its location and triggers, and a neurological exam. Tests depend on the type:
- MRI for trigeminal neuralgia, to look for a blood vessel pressing on the nerve, MS or a tumor
- blood tests for diabetes, vitamin B12, thyroid function
- nerve conduction studies for peripheral nerve problems
- diagnostic nerve blocks, for example for occipital neuralgia
Treatment
Medicines
- carbamazepine or oxcarbazepine: first-line treatment for trigeminal neuralgia
- gabapentin or pregabalin: for postherpetic neuralgia and other nerve pain
- amitriptyline, nortriptyline or duloxetine: antidepressants used at low doses for nerve pain
- topical lidocaine patches or capsaicin cream or patches for localized pain such as postherpetic neuralgia
Standard painkillers such as acetaminophen and NSAIDs usually help little. Opioids are generally not recommended for long-term nerve pain.
Procedures
- nerve blocks with local anesthetic and steroid, especially for occipital neuralgia
- botulinum toxin injections in selected cases
- microvascular decompression: surgery to move a blood vessel off the trigeminal nerve; offers the longest relief for suitable patients
- radiofrequency ablation, balloon compression, glycerol injection or stereotactic radiosurgery for trigeminal neuralgia when surgery is not suitable
- spinal cord or peripheral nerve stimulation for some chronic cases
Self-care
- avoid known triggers where possible, such as cold wind for trigeminal neuralgia
- warm or cool packs for occipital neuralgia
- gentle neck exercises and posture changes
- psychological approaches such as CBT and mindfulness for coping with chronic pain
Prevention
The shingles vaccine (recombinant zoster vaccine) is recommended for adults 50 and older and some younger adults with weakened immunity. It greatly reduces the risk of shingles and postherpetic neuralgia. Good blood sugar control helps prevent diabetic nerve damage.
Frequently asked questions
What does neuralgia feel like?
Neuralgia usually feels like sharp, stabbing, shooting or electric shock-like pain along a nerve. Some types cause constant burning or aching. Light touch, chewing, wind or temperature changes can trigger attacks.
What is the most common type of neuralgia?
Postherpetic neuralgia, which follows shingles, is one of the most common, especially in older adults. Trigeminal neuralgia is the most common facial neuralgia. Sciatica is a very common form of nerve root pain.
How is neuralgia treated?
Treatment usually starts with nerve pain medicines such as carbamazepine for trigeminal neuralgia, or gabapentin, pregabalin or amitriptyline for other types. Topical lidocaine or capsaicin, nerve blocks and surgery to relieve nerve compression are options when medicines are not enough.
Does neuralgia go away?
Some types improve on their own, such as postherpetic neuralgia in many people over months. Trigeminal neuralgia often comes in episodes with pain-free periods but tends to recur. Treatment can control pain effectively in most cases.
Sources
This guide was written from current patient and clinical guidance, including:
- National Institute of Neurological Disorders and Stroke: Trigeminal neuralgia; Peripheral neuropathy
- American Academy of Neurology/European Academy of Neurology: Trigeminal neuralgia management guideline
- NICE: Neuropathic pain in adults: pharmacological management (CG173)
- MedlinePlus: Neuralgia
- CDC: Shingles complications