People often confuse migraine symptoms with something called neuralgia. The former refers to an often disabling neurological condition characterized by severe and sometimes frequent headaches. The latter literally means “nerve pain” with the implication that the condition in question is secondary to some type of nerve injury or dysfunction. While migraines can be sub-classified in any number of ways, at their core, migraines are caused by chemical dysregulation. This dysregulation can cause blood vessels to become dilated instead of constricted or vice-versa, neurons to fire abnormally (e.g., like epilepsy, but with an aura instead of a seizure) or certain other chemicals to be present at abnormal levels (e.g., serotonin or calcitonin gene-related peptide). By contrast, peripheral nerve surgeons think of neuralgia as a mechanical problem – in other words something directly pressing on or irritating a nerve.
I routinely see patients in my office who have carried a diagnosis of migraines for many years when what they really have is neuralgia. In fact, while there are over 39 million migraine sufferers in the US alone, there are approximately 6.5 million chronic migraine sufferers. That means they have headaches at least 15 days out of every month. By definition, standard treatment has failed these patients. So, when someone presents to the office and has a history of chronic headaches, how do you tell whether they are suffering from neuralgia or migraines or some other form of headache. The keys are to perform a thorough history, a specific physical exam trying to discern the answer to the question above, and finally sequential nerve blocks if neuralgia is suspected.
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