2.0 Types of Neuropathic Facial Pain

By Anne B. Ciemnecki, MA (USA)

When we think about facial pain, most of us think about trigeminal neuralgia or trigeminal neuropathy. We think of pain in one or more of the three distributions of the trigeminal nerve. Put simply, the pain can occur near the eye, cheek, or jaw. It can be episodic, characterized by brief periods of lightning-like pain lasting for a few seconds to a few minutes, a refractory or rest period, another bolt from the blue, another refractory period, and so on. Or, it can be neuropathic, a lower level of aching, creepy, annoying pain that does not go away. Or it could be both.

Sadly, there are many more forms of neuropathic facial pain.

• Glossopharyngeal neuralgia
• Geniculate neuralgia
• Occipital neuralgia
• Hemifacial spasm
• Burning mouth syndrome
• Anesthesia dolorosa
• Postherpetic neuralgia
• Autonomic effects of trigeminal nerve injury
• Bilateral facial pain
• Medical causes of facial pain

As an overview we present a short anatomy lesson on cranial nerves. The names, functions, and locations of the 12 cranial nerves are presented in Figure 2-1.

Figure 2-1. Names, functions, and locations of the 12 cranial nerves.

There are 12 pairs of cranial nerves that emerge directly from the brain stem and carry information between the brain and parts of the body, especially the head and neck. The nerves are numbered with Roman numerals, I through XII, according to the order in which they emerge from the brain (from top to bottom). Note that some are solely sensory nerves, some are solely movement nerves, and some are both. Each nerve in the following list is labeled with an “S” for sensory, an “M” for movement, or a “B” for both.

1. Olfactory nerve: sense of smell (S)
2. Optic nerve: ability to see (S)
3. Oculomotor nerve: ability to move and blink your eyes (M)
4. Trochlear nerve: ability to move your eyes up and down or back or forth (M)
5. Trigeminal nerve: sensations in your face and cheeks, taste, and jaw movements (B)
6. Abducens nerve: ability to move your eyes (M)
7. Facial nerve: facial expressions and sense of taste (B)
8. Auditory/vestibular nerve: sense of hearing and balance (S)
9. Glossopharyngeal nerve: ability to taste and swallow (B)
10. Vagus nerve: digestion and heart rate (B)
11. Accessory nerve (also called spinal accessory nerve): ability to move shoulder and neck muscles (M)
12. Hypoglossal nerve: ability to move your tongue (M)

Note that the occipital nerve, the culprit in occipital neuralgia, is NOT a cranial nerve. It originates from the upper cervical spine.