Neuralgia: facial pain, shingles and when to seek help

Neuralgia means pain associated with an irritated or damaged nerve. It may feel burning, shooting or like an electric shock. Different types have different causes and need different approaches to assessment and treatment. This article explains facial nerve pain and pain after shingles; for pain travelling down the leg, see our sciatica guide.

Pain after shingles (post-herpetic neuralgia)

After chickenpox, the virus can remain inactive in the body and reactivate as shingles. Shingles usually causes a painful rash on one side, and can affect the trunk or face. Pain that continues after the rash has healed is called post-herpetic neuralgia. The skin may remain sensitive enough for clothing or light touch to hurt.

Not everyone who has shingles develops lasting nerve pain. Speak to your GP if pain in the affected area is not improving. Treatment may include prescribed nerve-pain medicines or referral to a pain specialist. See the NHS advice on post-herpetic neuralgia.

Trigeminal Neuralgia

The trigeminal nerve carries sensation from the face to the brain. Trigeminal neuralgia is often associated with a blood vessel pressing on the nerve near the brainstem, although other causes are possible and sometimes no cause is identified. It needs medical assessment; it is not an ordinary trapped nerve that can be released with hands-on treatment.

Trigeminal neuralgia typically causes brief attacks of severe pain on one side of the face, often around the jaw, teeth or gums. The area affected varies and is not a fixed fraction of the face. Washing, eating, brushing teeth or light touch can trigger an attack. See a GP for frequent or persistent facial pain, especially once dental causes have been excluded.

When to seek prompt help

If you think you have shingles, contact a pharmacist or NHS 111 promptly; treatment works best when started early. Seek an urgent GP appointment or NHS 111 advice for a rash on the eye or nose, changes to vision, or a severely weakened immune system. See the NHS shingles guidance for other situations requiring urgent advice.

Managing Nerve Pain

Management depends on the diagnosis. Trigeminal neuralgia treatment usually starts with prescription medicine; some people need specialist treatment. Persistent pain after shingles also needs a medical management plan. Osteopathy cannot replace this medical care or remove the underlying cause.

For back-related leg pain such as sciatica, an osteopathic assessment can help establish whether musculoskeletal care is appropriate or medical referral is needed. Any care plan should be based on the findings and your goals, without promising to resolve nerve pain. Repeatedly touching a painful facial area to try to increase its tolerance is not advice this article recommends.

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