Symptoms of Neuralgia
Neuralgia presents with sudden, severe, brief episodes of sharp, shooting, electric shock-like pain in the distribution of the affected nerve, typically lasting seconds to minutes, often triggered by minimal stimulation such as light touch, talking, or eating. 1
Core Pain Characteristics
The hallmark symptom is paroxysmal pain with these defining features:
- Sharp, shooting, electric shock-like quality described as stabbing or lancinating 1, 2
- Brief duration: attacks last seconds to minutes (typically 2 seconds to 2 minutes) 1
- Severe to excruciating intensity (moderate to very severe) 1, 3
- Unilateral distribution following specific nerve pathways 1, 2
- Refractory period between attacks in classical presentations 1
Triggering Factors
Attacks are characteristically provoked by seemingly innocuous stimuli:
- Light touch to trigger zones on the face or affected area 1, 2
- Daily activities: talking, chewing, brushing teeth, shaving 1, 4
- Environmental factors: cold wind, washing the face 1
- Eating or swallowing (depending on nerve involved) 1
Associated Sensory Changes
Beyond the pain itself, patients may experience:
- Allodynia: pain from normally non-painful stimuli 1
- Hyperalgesia: exaggerated pain response 1
- Dysesthesia: abnormal unpleasant sensations 1
- Facial spasms during intense attacks 2
Continuous Pain Variants
Important caveat: Some neuralgias present with continuous symptoms rather than purely paroxysmal attacks:
- Post-herpetic neuralgia: continuous burning, tingling, itchy, tender pain with sharp components 1
- Post-traumatic neuropathic pain: continuous burning and tingling with sharp episodes 1
- Type 2 trigeminal neuralgia: prolonged continuous pain between characteristic sharp attacks 5
Small Fiber Neuropathy Symptoms
In diabetic and other small fiber neuralgias, symptoms include:
- Prickling, aching, burning pain 1
- Intermittent sharp stabbing electric shock-like pains 1
- Nocturnal exacerbation 1
- Distal, symmetrical distribution 1
Psychological Impact
The severity and unpredictability of attacks lead to:
- Fear and anxiety about triggering attacks 1
- Severe depression if pain is uncontrolled 1
- Avoidance behaviors: neglecting facial hygiene, poor diet due to fear of triggering pain 4
Location-Specific Presentations
Trigeminal neuralgia: Unilateral pain in second and third divisions most commonly (cheek, jaw, teeth areas) 1
Glossopharyngeal neuralgia: Deep in ear, back of tongue, tonsils, neck; triggered by swallowing or coughing 1
Post-herpetic neuralgia: Site of previous herpes zoster outbreak 1