Neuralgia Nerve Pain: Your Guide to Types, Triggers, and Treatment
Know about neuralgia, what it is, common causes, recognising the symptoms, diagnosis, types of neuralgia, prevention and more.
Written by Dr. J T Hema Pratima
Reviewed by Dr. D Bhanu Prakash MBBS, AFIH, Advanced certificate in critical care medicine, Fellowship in critical care medicine
Last updated on 12th Sep, 2025
Introduction
Imagine a sudden, electric shock-like pain flashing across your cheek when you brush your teeth. Or a persistent, burning sensation on your skin long after a shingles rash has healed. This is the reality of neuralgia, a complex condition characterised by nerve pain that arises from damage or irritation. This guide will demystify neuralgias, exploring the various types from the well-known trigeminal neuralgia to the lesser-known occipital neuralgia. Understanding this condition is the first step toward managing it and reclaiming your comfort.
What is Neuralgia? More Than Just a Nerve Pain
At its core, neuralgia is a stabbing, burning, and often severe pain that occurs due to a damaged or irritated nerve. The nerve itself, which should be faithfully carrying signals from your body to your brain, becomes the source of the problem. It sends erratic, exaggerated pain signals without any actual cause for pain, like an internal fire alarm going off without a fire.
Think of a healthy nerve like a well-insulated electrical wire. The inner part (the axon) carries the signal, and the outer sheath (the myelin) protects it and ensures the signal travels smoothly. Nerve damage from ageing, disease, or injury can strip away this insulation (demyelination) or put pressure on the nerve. This leads to "short-circuiting," resulting in the characteristic jolts of pain, even from gentle, everyday stimuli like a breeze or light touch, a condition known as allodynia.
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How a Healthy Nerve vs. an Irritated Nerve Works
A healthy nerve transmits signals only when stimulated. An irritated or damaged nerve, however, fires spontaneously and excessively. It can become hyperexcitable, reacting to non-painful triggers as if they were major threats. This malfunction is the engine behind the debilitating pain of chronic nerve pain conditions.
Unmasking the Culprit: Common Causes of Neuralgia
Pinpointing the exact cause of neuralgia can be challenging, as sometimes it arises with no clear trigger (idiopathic neuralgia). However, several common culprits are well-documented.
Pressure on Nerves: This is a primary cause. A blood vessel, bone, tumour, or swollen muscle can compress a nerve, leading to pain. This is famously the case in most classic Trigeminal Neuralgia, where an artery presses on the trigeminal nerve near the brainstem.
Ageing: As we age, our nerves can naturally lose their protective myelin sheath, making them more vulnerable to irritation.
Infections: Viral infections are a major trigger. The herpes zoster virus, which causes shingles, is the direct cause of Postherpetic Neuralgia. Lyme disease and HIV can also lead to nerve pain.
Chronic Diseases: Conditions like diabetes (diabetic neuropathy), multiple sclerosis (MS), and kidney disease can cause nerve damage throughout the body.
Chemical Irritants: Certain medications or toxins can damage nerves.
Physical Trauma: Surgery, injury, or even prolonged poor posture can injure a nerve and lead to persistent pain.
The Shingles Connection: Postherpetic Neuralgia
This specific type deserves special attention. After a shingles infection clears, the virus can remain and damage the nerve fibres. This damage disrupts normal signalling, causing the nerve to send constant, often burning, pain signals from the skin to the brain. It's a common complication, affecting up to 18% of shingles patients, with risk increasing with age.
A Spectrum of Pain: Recognising Neuralgia Symptoms
Neuralgia symptoms are distinct from muscle or joint pain. They are directly linked to the pathway of the affected nerve.
The hallmark signs include:
Shooting, stabbing, or electric shock-like pain: Episodes are often sudden and intense.
A constant burning or aching pain: This is common in postherpetic neuralgia.
Pain triggered by light touch or non-painful stimuli: Gentle contact with the face (shaving, applying makeup) or a light breeze can set off a painful episode.
Pain located along the path of a specific nerve: For example, trigeminal neuralgia pain follows the branches of the trigeminal nerve (jaw, cheek, forehead).
Numbness or loss of function: In some cases, the pain may be preceded or accompanied by a loss of sensation.
When to See a Doctor: Warning Signs Not to Ignore
Do not dismiss persistent nerve pain. If symptoms persist beyond two weeks, consult a doctor online with Apollo24|7 for further evaluation. Seek immediate medical attention if:
The pain is sudden and severe.
You experience weakness or paralysis alongside the pain.
The pain follows a recent injury or surgery.
You have other symptoms like fever, unexplained weight loss, or bladder/bowel changes.
Types of Neuralgia: It's Not One-Size-Fits-All
Trigeminal Neuralgia: The "Suicide Disease"
TN is perhaps the most well-known and most excruciating type. It affects the trigeminal nerve, which carries sensation from your face to your brain. A simple trigger can cause episodes of intense, shooting pain that feels like an electric shock. Its historical nickname underscores its severity, though modern treatments have made it manageable.
Occipital Neuralgia: The Root of Headache Pain
This type involves the occipital nerves that run from the top of your spinal cord up the back of your scalp. Irritation here causes sharp pain at the back of the head, often mistaken for a migraine. The pain is typically one-sided and can be felt behind the eye.
Postherpetic Neuralgia: A Lingering Shadow of Shingles
As discussed, PHN is a complication of shingles. The pain is confined to the area of the skin where the shingles outbreak occurred, often as a torso or face. It can be a constant, burning sensation that makes even the touch of clothing unbearable.
Other Less Common Neuralgias
It includes:
Glossopharyngeal neuralgia: Causes pain in the throat, tongue, tonsil, and ear, often triggered by swallowing.
Pudendal neuralgia: Causes pain in the "saddle area" between the legs, often worse when sitting.
Sciatica: Pain along the sciatic nerve, running from the lower back down the leg.
Getting a Diagnosis: How Doctors Identify Neuralgia
Diagnosis begins with a detailed conversation. A doctor will ask about your pain's nature, location, triggers, and duration. A neurological exam to test reflexes, sensation, and nerve function is crucial.
Diagnostic Tests: Ruling Out Other Conditions
There is no single test for neuralgia. Diagnosis often involves ruling out other causes. Tests may include:
MRI scans: To look for MS, tumours, or blood vessels pressing on a nerve.
CT scans: Can reveal other structural issues.
Blood tests: To check for diabetes, infections, or vitamin deficiencies (e.g., B12). Apollo24|7 offers convenient home collection for tests like these to help rule out underlying causes.
Finding Relief: Treatment Options for Neuralgia
Treatment focuses on pain relief and managing underlying causes. A multi-pronged approach is often most effective.
First-Line Defense: Medications to Calm Nerves
Standard pain relievers like ibuprofen are often ineffective. Doctors typically prescribe:
Anticonvulsants: Drugs like carbamazepine (first-line for TN) and gabapentin stabilise nerve membranes and reduce erratic firing.
Antidepressants: Tricyclic antidepressants (e.g., amitriptyline) alter chemical signals in your spinal cord that are involved in pain perception.
Topical creams: Capsaicin or lidocaine patches can numb local nerve endings.
Beyond Pills: Therapies and Procedures
Physical Therapy: Can help with muscle-related nerve compression.
Nerve Blocks: An injection of anaesthetic (like a steroid) to temporarily block pain signals from a specific nerve.
Ablation: Procedures that use heat, balloon compression, or chemicals to deliberately damage the nerve to stop it from sending pain signals (the effect may wear off over time).
Surgical Interventions for Severe Cases
For cases like TN, where a blood vessel is compressing the nerve, Microvascular Decompression (MVD) surgery can be highly effective. The surgeon moves the offending vessel away from the nerve and cushions it with a pad.
Living Well: Lifestyle and Home Remedies
It includes:
Stress Management: Stress is a major trigger for many. Yoga, meditation, and mindfulness can help.
Acupuncture: Some find significant relief from this traditional practice.
Gentle Exercise: Improves blood flow and releases endorphins, the body's natural painkillers.
Balanced Diet:* Ensuring adequate intake of B vitamins is crucial for nerve health.
Can Neuralgia Be Prevented?
You can't prevent all neuralgias, but you can reduce your risk:
Get vaccinated: The shingles vaccine (Shingrix) is the most effective way to prevent shingles and subsequent postherpetic neuralgia.
Manage chronic conditions: Keeping diabetes under tight control helps prevent diabetic neuropathy.
Maintain a healthy lifestyle: Regular exercise and a balanced diet support overall nerve health.
Practice good posture: It reduces the risk of nerve compression in the neck and back.
Conclusion
Living with neuralgia can feel isolating and overwhelming, but it's important to remember that you are not alone and that help is available. From identifying your specific triggers to exploring a range of treatment options, from medications like gabapentin to advanced procedures there is a path to significant relief. While the journey may require patience and working closely with a neurologist or pain specialist, modern medicine offers more tools than ever to manage this condition effectively. If your condition does not improve after trying conservative methods, book a physical visit to a doctor with Apollo24|7.
Consult a Neurologist for Personalised Advice
Consult a Neurologist for Personalised Advice
Dr. Lakshaman K
Neurologist
19 Years • MBBS,MS General Medicine,MCH Neurosurgery
Bengaluru
R V speciality Clinic, Bengaluru
Dr. Ganeshgouda Majigoudra
Neurologist
10 Years • MBBS, MD ( GENERAL MEDICINE) DM (NEUROLOGY)
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr. Joydeep Biswas
Neurologist
15 Years • MBBS, DNB General Medicine, DNB Neurology
Barasat
Diab-Eat-Ease, Barasat
Dr. Uddalak Chakraborty
Neurologist
8 Years • MBBS, MD(GENL.MED.),DM(NEUROLOGY)
Kolkata
MCR SUPER SPECIALITY POLY CLINIC & PATHOLOGY, Kolkata
(25+ Patients)
Dr. Avinash Gupta
Neurologist
12 Years • MBBS, DNB - Neurology
Bilaspur
Apollo Hospitals Seepat Road, Bilaspur
(125+ Patients)
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Frequently Asked Questions
1. What is the difference between neuralgia and neuropathy?
.While both involve nerve issues, neuropathy is a broader term for nerve damage that often causes numbness, weakness, and pain, typically in the hands and feet (like diabetic neuropathy). Neuralgia is a specific type of neuropathic pain that is often more localised and characterised by intense, episodic pain along the course of a single nerve.
2. Is neuralgia a sign of something more serious, like a brain tumour?
While it can be, it is rare. Pressure from a tumour is one potential cause of neuralgia, which is why doctors often use MRI scans to rule out such serious underlying conditions. Most commonly, neuralgia is caused by high blood pressure, ageing, or past infections like shingles.
3. What are the best natural remedies for nerve pain?
Some people find relief with supplements like alpha-lipoic acid, acetyl-L-carnitine, and B vitamins (B1, B6, B12). Capsaicin cream derived from chilli peppers can desensitise nerve endings. Always consult your doctor before starting any supplements, as they can interact with medications.
4. Can stress make neuralgia worse?
Absolutely. Stress is a very common trigger for neuralgia flare-ups. It can heighten your nervous system's sensitivity and lower your pain threshold. Incorporating stress-reduction techniques like meditation, deep breathing, or gentle yoga is a critical part of managing the condition.
5. Is neuralgia pain constant?
It depends on the type. Postherpetic neuralgia often involves a constant burning background pain. Trigeminal neuralgia, however, is typically characterised by sudden, severe, episodic attacks that last from a few seconds to a few minutes, with pain-free periods in between.