Personalized Treatment of Cranial Neuralgias: Paul G. Mathew, MD, DNBPAS, FAAN, FAHS

"Because of the society we’re living in, when we’re typing, texting, eating, driving, we’re in this anterior position that puts a lot of tension on those muscles and generates a lot of bad chronic posture. Even something as simple as that, over the years, can lead to the development of occipital neuralgia.” 

In clinical practice, posttraumatic headache can manifest as a new type of headache with unique features from any previously experienced headache or a worsening in frequency and/or intensity of a pre-existing headache disorder. As in the case with primary headache disorders, the diagnosis of comorbid focal painful cranial neuralgias can often be missed in patients who present with posttraumatic headache. These neuralgias can manifest as brief, sharp, lancinating pain in a particular nerve distribution, and palpation where the nerve exits the skull may produce the pain. 

A recently conducted case study involving 2 patients with posttraumatic headache later diagnosed with auriculotemporal neuralgia and supratrochlear neuralgia, respectively, helped uncover more about the condition which some, including lead investigator Paul G. Mathew, MD, DNBPAS, FAAN, FAHS, consider “overlooked” within the headache space. Treatment options for painful cranial neuralgias are different than those traditionally employed for posttraumatic headache without cranial neuralgias, which can include peripheral nerve blockade, neuropathic medications, and in some refractory cases, peripheral nerve decompression surgery. 

Mathew, an assistant professor of neurology at Harvard Medical School, also concluded in his research that an increased awareness for these neuralgias may lead to more specific and effective treatments and subsequent overall improvement in patient outcomes. He sat down with NeurologyLive to discuss the difficulties in treating patients with cranial neuralgias and why thorough examination and questioning is key to guiding patients towards making the correct treatment decisions.