| Entity | Nerve / anatomic distribution | Hallmark phenotype / triggers | Typical etiology | Epidemiology | Diagnostic emphasis | First-line treatment | Procedural options | Key recent evidence / statistics |
|---|---|---|---|---|---|---|---|---|
| **Cranial neuralgia (umbrella category)** | Pain in distributions of cranial nerves; major entities include trigeminal, occipital, glossopharyngeal, and nervus intermedius neuralgias (pqac-00000000, pqac-00000015) | Classically unilateral, paroxysmal, shock-like pain; some patients have continuous background pain; autonomic features may occur in a substantial minority (pqac-00000000, pqac-00000015) | Often neurovascular compression in primary/classical forms; secondary causes must be excluded (tumor, demyelination, vascular malformation, trauma, infection depending on subtype) (pqac-00000000, pqac-00000011, pqac-00000012) | **Umbrella-level gap:** no single robust prevalence/incidence estimate for all cranial neuralgias combined. In a 2024 meta-analysis, **40%** of patients with craniofacial neuralgias had ≥1 autonomic feature; excluding TN, autonomic features were reported in **28%** of pain events (95% CI **2–90%**) (pqac-00000015) | Clinical classification plus targeted exclusion of secondary causes; MRI/MRA emphasized for primary neuralgias, especially when neurovascular compression is suspected (pqac-00000000) | Drug therapy generally relies on antiepileptics, antidepressants, and baclofen; subtype-specific first-line choice varies (pqac-00000000) | Ablation, radiofrequency procedures, gamma knife/radiosurgery, neuromodulation, and microvascular decompression in selected refractory/compressive cases (pqac-00000000, pqac-00000008) | 2024 systematic review quantified autonomic features hierarchy: lacrimation most common overall; ptosis and sweating least common (pqac-00000015) |
| **Trigeminal neuralgia (TN)** | CN V; one or more trigeminal divisions (V1/V2/V3), often unilateral facial distribution; right side may be more common in some series (pqac-00000001, pqac-00000012) | Brief recurrent electric shock-like or stabbing facial pain triggered by innocuous stimuli such as chewing, speaking, tooth-brushing, touch; some patients develop continuous pain superimposed on paroxysms (pqac-00000001, pqac-00000005, pqac-00000013) | Classical TN: neurovascular compression with demyelination; secondary TN: multiple sclerosis, tumors, vascular malformations, ischemic/space-occupying lesions; idiopathic TN has no identified cause (pqac-00000001, pqac-00000005, pqac-00000006, pqac-00000012) | Annual incidence reported as **4.5–28.9/100,000**; lifetime prevalence about **0.3%** in one review; more common in middle-aged/older women; MS patients have markedly increased risk, with TN prevalence **1.9–4.9%** in MS and ~15–20-fold excess risk in reviews (pqac-00000003, pqac-00000001, pqac-00000012) | Diagnosis is primarily clinical using ICHD-3 features; MRI/MRA used to detect neurovascular compression and rule out secondary causes; diagnostic confusion with dental/TMJ disorders and headache syndromes is common (pqac-00000000, pqac-00000005) | **Carbamazepine or oxcarbazepine** (voltage-gated sodium-channel blockers) are standard first-line therapy (pqac-00000001, pqac-00000005, pqac-00000013) | Microvascular decompression (MVD); radiofrequency thermocoagulation/ablation; balloon compression; glycerol procedures; gamma knife; botulinum toxin in refractory disease; investigational peripheral nerve stimulation and imaging-guided RFT strategies (pqac-00000000, pqac-00000013, pqac-00000009) | 2024 UK Biobank genetic study: **555** TN cases vs **6,245** controls; **C8B rs706484 OR 1.357 (1.158–1.590), p=0.00016** and **MFG-E8 rs2015495 OR 1.313 (1.134–1.521), p=0.00028**; both eQTLs (pqac-00000006). 2023 fully endoscopic MVD series: TN effective rate **98.9%** (105 complete, 5 significant, 4 partial relief) with **11 recurrences** over mean **18.6 ± 3.3 months** (pqac-00000012). 2019 BTX-A cohort: **83.7%** success, **16.3%** mild side effects; age ≥50 predicted better response (pqac-00000013). 2024 review cites MVD meta-analytic pain-free rate **92.9% [89.1–96.8]** after 5 months to 5 years (pqac-00000004) |
| **Glossopharyngeal neuralgia (GPN)** | CN IX distribution: mandibular angle, ear, tonsillar fossa, posterior pharynx, base of tongue; may associate with vagal/cardiovascular symptoms in severe cases (pqac-00000011, pqac-00000012) | Transient stabbing pain triggered by **coughing, talking, swallowing, yawning** (pqac-00000011) | Commonly neurovascular compression near brainstem root entry zone; also trauma, skull-base or posterior fossa tumors, infections, surgery (pqac-00000011) | Annual incidence estimated **0.2–0.7/100,000** in one surgical review and **0.8/100,000/year** in another; tends to increase with age and most often occurs in adults **>50 years** (pqac-00000012, pqac-00000011) | Clinical diagnosis supported by anatomic pain distribution and trigger history; MRI evidence of compressing vessel may guide selection for MVD; secondary causes require exclusion (pqac-00000011, pqac-00000012) | **Carbamazepine**; alternatives include gabapentin and eslicarbazepine acetate per review literature (pqac-00000011, pqac-00000004) | MVD, percutaneous radiofrequency thermocoagulation (PRT), pulsed radiofrequency, nerve blocks, rhizotomy, stereotactic radiation in selected reports (pqac-00000011, pqac-00000004, pqac-00000012) | 2023 comparative study found both PRT and MVD significantly reduced VAS and PSQI; at **48 weeks**, complete remission was significantly higher with **MVD** than PRT, while hospital stay, operative time, and cost were also higher with MVD; no significant adverse-event difference (pqac-00000011). 2023 endoscopic MVD series reported GPN effective rate **100%** (**10/10** complete relief) (pqac-00000012) |
| **Occipital neuralgia (ON)** | Typically greater/lesser/third occipital nerve distribution in posterior scalp/upper neck; often considered among common cranial/cervico-cranial neuralgias in practice (pqac-00000000, pqac-00000008) | Paroxysmal occipital or upper-neck pain, often with tenderness over occipital nerves; may overlap with cervicogenic headache syndromes (**detailed phenotype data limited in gathered set**) (pqac-00000000, pqac-00000008) | Heterogeneous; may involve nerve irritation/entrapment, trauma, or cervical pathology, but **umbrella-level gathered evidence here is limited** (pqac-00000000) | **Data gap in gathered evidence:** no robust contemporary incidence/prevalence figure retrieved in current evidence set | Primarily clinical; distinction from cervicogenic headache and other posterior head pain syndromes is important; interventional studies frequently use occipital nerve-targeted approaches (pqac-00000008) | **Evidence gap in gathered set:** no single universally cited first-line drug regimen retrieved here | Occipital nerve block, pulsed radiofrequency/radiofrequency ablation, platelet-rich plasma, and peripheral nerve stimulation under study (clinical trials) (pqac-00000008) | Current implementations/trials include SPRINT® occipital **peripheral nerve stimulation** case-series study, **NCT05491915**, active-not-recruiting, estimated **n=50**; primary outcomes include reduction in average pain/pain interference and adverse events through follow-up to 24 months (pqac-00000008) |
| **Nervus intermedius neuralgia** | CN VII nervus intermedius / deep ear canal region (**specific detailed anatomic evidence limited in gathered set**) (pqac-00000000) | Very rare neuralgia; typically severe paroxysmal neuralgic pain in its sensory territory, but **detailed contemporary phenotype evidence not retrieved in current set** (pqac-00000000) | Often presumed compressive or secondary causes should be excluded, but **subtype-specific evidence sparse** in gathered sources (pqac-00000000) | **Major data gap:** no reliable incidence/prevalence estimate retrieved in current evidence set | Careful workup for secondary causes; diagnosis remains uncommon and literature sparse (pqac-00000000) | **No subtype-specific first-line evidence retrieved in current set**; management often extrapolated from other cranial neuralgias (pqac-00000000) | Case-based invasive strategies may be used, but **no robust contemporary procedural dataset retrieved here** | Key message is rarity and evidence scarcity rather than quantified outcomes in current gathered literature (pqac-00000000) |


*Table: This table summarizes the main cranial neuralgia subtypes using only already-gathered evidence, separating umbrella-level conclusions from subtype-specific findings. It highlights where evidence is strong for trigeminal and glossopharyngeal neuralgia and where important gaps remain for occipital and nervus intermedius neuralgia.*