Background

Cranial neuralgias are common in the setting of posttraumatic headache. They may exacerbate underlying primary headache disorders and therefore may be overlooked in clinical practice. Frequently, cranial neuralgias generate neuropathic symptoms such as lancinating pain and sensory dysesthesias. Cranial neuralgias are identified based on a clinical history of focal neuropathic pain and physical exam findings including tenderness with palpation and percussion, at times eliciting radiating pain or paresthesias in the corresponding sensory nerve distribution.

Purpose of Review

This article is a brief review of the literature and a retrospective report of 2 cases of posttraumatic headache with associated painful cranial neuralgias.

Recent Findings

Two patients presented with headaches that met criteria for posttraumatic headache, but their history and physical examination suggested the presence of a focal painful cranial neuralgia. One patient was diagnosed with auriculotemporal neuralgia, which was exquisitely responsive to an auriculotemporal nerve block. The second patient was diagnosed with supratrochlear neuralgia, which was effectively treated with a supratrochlear nerve block. In both cases, adequate treatment of the painful cranial neuralgia resulted in significant improvement of the baseline PTH.

Summary

Painful cranial neuralgias frequently occur within the clinical spectrum of posttraumatic headache, but are often undiagnosed. Treatment options for painful cranial neuralgias are often different than those traditionally employed for posttraumatic headache without cranial neuralgias, which can include peripheral nerve blockade, neuropathic medications, and in refractory cases, peripheral nerve decompression surgery.

中文翻译：

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伴有疼痛性颅神经痛的创伤后头痛的诊断和治疗：综述和病例系列

背景

颅神经痛在创伤后头痛的情况下很常见。它们可能会加剧潜在的原发性头痛疾病，因此在临床实践中可能会被忽视。通常，颅神经痛会产生神经性症状，例如刺痛和感觉迟钝。颅神经痛是根据局灶性神经性疼痛的临床病史和体格检查结果来确定的，包括触诊和叩诊压痛，有时会在相应的感觉神经分布中引起放射痛或感觉异常。

审查目的

本文对2例创伤后头痛合并痛性颅神经痛进行文献综述和回顾性报告。

最近的发现

两名患者出现符合创伤后头痛标准的头痛，但他们的病史和体格检查表明存在局灶性疼痛性颅神经痛。一名患者被诊断为耳颞神经痛，对耳颞神经阻滞反应良好。第二位患者被诊断为滑车上神经痛，滑车上神经阻滞有效治疗。在这两种情况下，疼痛性颅神经痛的充分治疗导致基线 PTH 的显着改善。

概括

疼痛性颅神经痛经常发生在创伤后头痛的临床范围内，但往往未被确诊。疼痛性颅神经痛的治疗方案通常不同于传统上用于无颅神经痛的创伤后头痛的治疗方案，包括外周神经阻滞剂、神经性药物，以及在难治性病例中，外周神经减压手术。