How Can I Tell The Difference Between A Headache Or Migraine Vs Occipital Neuralgia
Occipital neuralgia is a rare condition, but when it does occur, its most often misdiagnosed at first. Conditions that share many of the same symptoms include:
There are a few tells that can help you determine if youre suffering from occipital neuralgia or another headache disorder, most notably migraines. However, do note that these differences can only be used in a general manner. Everyone will experience pain differently, so its always best to talk to a certified pain specialist to get a correct diagnosis. Misdiagnosing the cause of your pain can lead to ineffective treatments and sustained pain.
The major differences between migraines vs occipital neuralgia include:
- Type of pain: Migraine pain is most often dull, throbbing, and occurs over a few hours occipital neuralgia pain is typically episodic, sharp, and intense for short bursts of time
- Location of pain: Occipital neuralgia sufferers will experience pain upon palpation of the occipital nerves this may or may not occur for migraine patients
- Vision symptoms: Both cause vision issues, but eye watering and redness is more characteristic of other headaches, while occipital neuralgia tends to produce blurry vision or pain behind the eyes
- Pain triggers: Migraines, in particular, often have known triggers, like light, certain smells or foods, or stress occipital neuralgia most often occurs when turning or moving the head
Mechanism Of Referred Otalgia
Although the mechanism of referred otalgia is slightly controversial, the most accepted theory is the convergence-projection theory, which states that multiple nerves converge onto a single shared neural pathway, with the central nervous system unable to differentiate the origin of stimulation. In referred otalgia, there is a convergence of common sensory pathways between the complex sensory innervation supplying both the ear and cranial nerves innervating the head and neck, with the CNS unable to correctly pinpoint the location of pathology. This sensory error is analogous to a patient’s having pain in the medial left arm when experiencing an acute coronary syndrome or patient’s feeling pain in the shoulder when, in actuality, a lesion is irritating the patient’s diaphragm.
Nerve Inflammation Can Trigger Neuralgia
- Shingles inflammation of a nerve, caused by infection with the herpes virus. This common type of neuralgia is known as post-herpetic neuralgia. The pain may remain long after the shingles rash has disappeared, particularly in areas of the face
- Infection the nerve can be irritated by nearby infection, such as a tooth abscess
- Pressure or injury broken bones, slipped vertebral discs or certain tumours can press and irritate a nerve
- Syphilis in its advanced stages, this sexually transmitted disease affects the functioning of the nervous system.
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How Is Tn Diagnosed
TN diagnosis is based primarily on the persons history and description of symptoms, along with results from physical and neurological examinations. Other disorders that cause facial pain should be ruled out before TN is diagnosed. Some disorders that cause facial pain include post-herpetic neuralgia , cluster headaches, and temporomandibular joint disorder . Because of overlapping symptoms and the large number of conditions that can cause facial pain, obtaining a correct diagnosis is difficult, but finding the cause of the pain is important as the treatments for different types of pain may differ.
Most people with TN eventually will undergo a magnetic resonance imaging scan to rule out a tumor or multiple sclerosis as the cause of their pain. This scan may or may not clearly show a blood vessel compressing the nerve. Special MRI imaging procedures can reveal the presence and severity of compression of the nerve by a blood vessel.
A diagnosis of classic trigeminal neuralgia may be supported by an individuals positive response to a short course of an antiseizure medication. Diagnosis of TN2 is more complex and difficult, but tends to be supported by a positive response to low doses of tricyclic antidepressant medications , similar to other neuropathic pain diagnoses.
Ruling Out Other Conditions
An important part of the process of diagnosing trigeminal neuralgia involves ruling out other conditions that can also cause facial pain.
- joint pain in the lower jaw
- giant cell arteritis a condition in which medium and large arteries in the head and neck become inflamed and cause pain in the jaw and temples
- a possible injury to one of the facial nerves
Your medical, personal and family history will also need to be taken into consideration when determining possible causes of your pain.
For example, trigeminal neuralgia is less likely if you are under 40 years old, and multiple sclerosis may be more likely if you have a family history of the condition or if you have some other form of this condition. However, trigeminal neuralgia is very unlikely to be the first symptom of MS.
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When To Seek Medical Advice
The GP will try to identify the problem by asking about your symptoms and ruling out conditions that could be responsible for your pain.
However, diagnosing trigeminal neuralgia can be difficult and it can take a few years for a diagnosis to be confirmed.
Read more about diagnosing trigeminal neuralgia.
How Common Is Trigeminal Neuralgia
About 150,000 people each year are diagnosed with trigeminal neuralgia. Thats roughly 4.3 new cases per 100,000 people. Trigeminal neuralgia affects people over the age of 50 significantly more than it does people under the age of 40, where its considered rare. This condition also affects women more than men and is considered a rare disorder.
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Tinnitus Risk Increases When Diagnosed With Trigeminal Neuralgia
Researchers examined the risk of tinnitus within 1 year following trigeminal neuralgia using data from the Taiwan National Health Insurance Research Dataset, and a retrospective cohort study design.
Tinnitus is the auditory phantom sensation of sound in the absence of external stimuli. About 10% of the population suffers from tinnitus, making it one of the most common health conditions in the world . The most common cause of tinnitus is tinnitus associated with hearing loss caused by noise overexposure and aging. However, tinnitus can result from non-otologic causes, such as head and neck trauma , temporomandibular disorders , and cervical spine disorders . A certain percentage of patients find their tinnitus provoked by movement of or applying pressure to the head and neck region . Research has shown that the somatic origins of tinnitus may be due to interactions between somatic and auditory neuronal pathways in the central nervous system, indicating the role of somatosensory components in some cases of tinnitus .
Therefore, it is reasonable to hypothesize a prospective or comorbid association between trigeminal neuralgia and tinnitus. To the best of our knowledge, there is no documented study that explored tinnitus risk following a diagnosis of trigeminal neuralgia. This nationwide, population-based, retrospective cohort study was carried out to investigate the risk of tinnitus within 1 year following a diagnosis of trigeminal neuralgia.
Surgery For Trigeminal Neuralgia
If medication no longer controls your trigeminal neuralgia pain despite the increased dosage, or if the side effects are intolerable, there are several surgical procedures to consider. It helps to learn about these options before you are in urgent need of relief so you and your doctor have time to evaluate them. Your overall health, age, pain level and the availability of the procedure will all factor in to this decision. Most people with trigeminal neuralgia are candidates for any of the surgical treatment options your doctor can help you decide which ones and in what order you should consider them.
The surgery for trigeminal neuralgia is delicate and precise since the involved area is very small. Look for experienced neurosurgeons who see and treat a large number of people with trigeminal neuralgia.
There are several kinds of rhizotomies for trigeminal neuralgia, which are all outpatient procedures performed under general anesthesia in the operating room. The surgeon inserts a long needle through the cheek on the affected side of the face and uses an electrical current or a chemical to deaden the pain fibers of the trigeminal nerve. For those undergoing trigeminal neuralgia rhizotomy for the first time, the chemical approach is typically recommended. Those who have the procedure repeated often benefit from both the chemical and the heat treatment delivered in the same session.
Microvascular Decompression Surgery
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More Information And Support
Living with a long-term and painful condition such as trigeminal neuralgia can be very difficult.
You may find it useful to contact local or national support groups, such as the Trigeminal Neuralgia Association UK, for more information and advice about living with the condition, and to get in touch with other people who have the condition to talk to them about their experiences.
Research has shown that groups that have support from health care professionals provide high-quality help, which can significantly improve your ability to manage this rare condition. Learning from others how to cope can help remove the fear of more pain and reduce the risk of depression.
However, you need to be wary of potentially unreliable information you may find elsewhere, especially if offering cures for the condition. There is a great deal of misinformation on the internet, so do your research only on reliable websites, not on open forums or on social media.
There are a number of research projects running both in the UK and abroad to determine the cause of this condition and to find new treatments, including new medications, so there is always hope on the horizon.
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Rheumatoid Or Psoriatic Arthritis
These forms of arthritis occur because your immune system attacks healthy joints. Both rheumatoid and psoriatic arthritis are identified as autoimmune conditions.
You may experience joint pain throughout your body at different times, including in your TMJ, and certain triggers may cause the pain to flare up.
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How Is Trigeminal Neuralgia Treated
There is no specific test for trigeminal neuralgia so diagnosis and treatment depends on your description of your pain. You may have an MRI scan to rule out other conditions or to see if your MS is more active at the moment. An MRI scan can sometimes show if trigeminal neuralgia is due to a blood vessel pressing on the nerve inside the skull. This is known as compression and is the main cause of trigeminal neuralgia in the general population although not in people with MS.
Trigeminal neuralgia is a long term condition. Although there is no cure, it can usually be managed to some degree with treatment.
The Upper Cervical Chiropractic Difference
Upper cervical practitioners focus on the top two bones in the neck. These bones are most likely to affect the trigeminal nerve, blood flow to the head, and the brainstem. They use diagnostic imaging to take precise measurements of the misalignment. Then, gentle adjustments are tailored to meet each patients needs. This allows for safe and long-lasting low-force corrections to be used.
When adjustments are gentle, they tend to hold longer. Your body doesnt fight against it the way it would a forceful adjustment such as having the neck popped or twisted. As a result, the body has the time it needs to heal from the damage the misalignment was inflicting. Thus, results can be both immediate as well as gradual, as noted in both cases above.
If you are suffering from trigeminal neuralgia, give upper cervical chiropractic a try. A consultation with a practitioner near you may be your first step down the path to less face pain.
to schedule a consultation today.
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Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
How Is A Diagnosis Made
When a person first experiences throat pain, a primary care doctor or dentist is often consulted. If the pain requires further evaluation, a neurologist or a neurosurgeon may be recommended.
The diagnosis of neuralgia is made after carefully assessing the patient’s symptoms. If glossopharyngeal neuralgia is suspected, the doctor will attempt to trigger an episode by touching the back of the throat with a swab. If that causes pain, a topical anesthetic is applied to the back of the throat and the doctor will try the pain stimulus again. If pain is not triggered while the area is numb, glossopharyngeal neuralgia is diagnosed.
Other tests may include an MRI or MRA to look for tumors or a blood vessel compressing the nerve.
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Causes Of Trigeminal Neuralgia
Trigeminal neuralgia usually occurs spontaneously, but is sometimes associated with facial trauma or dental procedures.
The condition may be caused by a blood vessel pressing against the trigeminal nerve, also known as vascular compression. Over time, the pulse of an artery rubbing against the nerve can wear away the insulation, which is called myelin, leaving the nerve exposed and highly sensitive.
The resulting symptoms can be similar to those caused by dental problems, and sometimes people with undiagnosed trigeminal neuralgia explore multiple dental procedures in an effort to control the pain.
Multiple sclerosis or a tumor while rare can also cause trigeminal neuralgia. Researchers are exploring whether or not postherpetic neuralgia can be related to this condition.
What Is Glossopharyngeal Neuralgia
Neuralgia is severe pain caused by injury or damage to a nerve. The glossopharyngeal nerve is the ninth cranial nerve, which arises from the brainstem inside the skull. It supplies sensation to the back of the throat and tongue and portions of the ear .
When the glossopharyngeal nerve becomes irritated, an attack of intense electric shock-like pain is felt in the back of the throat, tongue, tonsil or ear. You may initially experience short, mild attacks, with periods of remission. But neuralgia can progress, causing longer, frequent attacks of searing pain.
Glossopharyngeal pain can be similar to trigeminal neuralgia â and misdiagnosed. Be sure to see a neurosurgeon who specializes in facial pain who can make the distinction.
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Diagnosis Of Ear Pain
JOHN W. ELY, MD, MSPH MARLAN R. HANSEN, MD and ELIZABETH C. CLARK, MD, MPH
University of Iowa Carver College of Medicine, Iowa City, Iowa
Am Fam Physician. 2008 Mar 1 77:621-628.
Ear pain is a common symptom in primary care with many possible causes. When the cause arises from the ear , the ear examination is usually abnormal and the diagnosis is typically apparent. In secondary or referred otalgia, the ear examination is usually normal, and the pain may be referred from a variety of sites.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Magnetic resonance imaging and referral for nasolaryngoscopy should be considered for patients with otalgia who have a normal ear examination and who have signs, symptoms, or risk factors for tumor .
|Clinical recommendation||Evidence rating||References|
Young , otherwise healthy adults with otalgia and a normal ear examination can be treated symptomatically. Referral is appropriate if symptoms persist.
Patients older than 50 years with unexplained otalgia and a normal ear examination should have an erythrocyte sedimentation rate measurement to help rule out temporal arteritis.
A = consistent, good-quality patient-oriented evidence B = inconsistent or limited quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 579 or .
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Does Trigeminal Neuralgia Get Worse Over Time
It certainly can. At first, the pain may be limited to the jaw area, which leads some with this disorder to think that its just a routine dental problem. But over time, the condition can get worse and worse, to the point that the pain-free moments between episodes become shorter and shorter, sometimes until theyre nonexistent. Additionally, the intensity of your pain may increase, making normal activities a burden and forcing you to eliminate simple, everyday tasks from your routine, for fear of an attack. Pain management can also be less effective over time.
A note from Cleveland Clinic
Trigeminal neuralgia isnt life-threatening but it can be life-altering. You may become afraid of performing certain normal activities, as they can bring on short, intense painful episodes. But, thankfully, there are different surgical procedures and treatment options that can help you live a normal, relatively pain-free life even if this is a condition that will likely be present, in some way, for your entire life.
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What Can I Do If I Have Trigeminal Neuralgia
If your pain feels like it might be associated with one or more of your teeth, then it is worth visiting the dentist first. It would be worth mentioning that you have MS and that trigeminal neuralgia may be a possibility. If the dentist can find nothing wrong with your teeth or suggests major dental work, such as an extraction or root canal, it may be worth exploring the possibility of trigeminal neuralgia before proceeding further.
Sometimes trigeminal neuralgia can give pain around the ear which feels similar to an ear infection. Your GP or practice nurse should be able to check this for you.
If you are concerned about your pain, contact your MS nurse or neurologist directly or ask your GP to refer you for assessment. It will be important to describe your pain as clearly as possible and to say if it is excruciating so that you are referred as soon as possible.