Expanding Cranial Neuralgia Research, Affiliated Surgeries: Paul G. Mathew, MD, DNBPAS, FAAN, FAHS

"The analogy that I give to many patients is that it’s like when you have an electrical problem inside of a house. You can take all the pictures you want outside and inside of the house, but it’s not going to show you the short circuit that’s causing the electrical problems.”

Cranial neuralgias, common in the setting of posttraumatic headache, can generate neuropathic symptoms such as lancinating pain and sensory dysesthesias. These neuralgias are identified based on a clinical history of focal neuropathic pain and physical examination findings including tenderness with palpation and percussion, at times eliciting radiating pain or paresthesia in the corresponding sensory nerve distribution.

Paul G. Mathew, MD, DNBPAS, FAAN, FAHS, recently conducted a case study that included 2 patients who met the criteria for posttraumatic headache, but upon further examination, suggested the presence of a focal painful cranial neuralgia. One patient was diagnosed with auriculotemporal neuralgia responded well to an auriculotemporal nerve block, while the second patient was diagnosed with supratrochlear neuralgia and was effectively treated with a supratrochlear nerve block.

Mathew, assistant professor of neurology, Harvard Medical School, has particular interest in uncovering more about those with refractory cases of posttraumatic headache and associated neuralgias. He sat down with NeurologyLive to provide context on areas within the space that need additional research, including expanding on the use of surgeries and identifying which patients should be eligible for them.