September 28, 2020, e-Pearl of the Week: Great Auricular Neuralgia (GAN)

Great Auricular Neuralgia

Great Auricular Neuralgia (GAN)—a craniocervical neuralgia—presents with paroxysmal spells of unilateral, sharp pain along the preauricular-parotid, gonial angle, and mastoid regions.1 Symptoms are reproducible by applying tactile pressure in the nerve distribution3 and rotation of the head to the opposite side.2 The great auricular nerve is a pure sensory branch of C2-C3 anastomosing with ansa cervicalis.1 The exact incidence of GAN is unknown due to the paucity of reported cases. Pathogenesis remains mostly idiopathic; however, secondary causes are surgery or tumors of the neck.2 Nerve block2 and high-resolution ultrasound over the sternocleidomastoid muscle5 aids in confirming the diagnosis. Differentials are trigeminal neuralgia and first bite syndrome.3 Therapeutic options include pregabalin, amitriptyline, with refractory cases responding effectively to nerve block.2

References

  1. Eghtesadi M, Leroux E, and Vargas-Schaffer G. (2017). A case report of complex auricular neuralgia treated with the great auricular nerve and facet blocks. J Pain Res 2017;10:435–438.
  2. Jeon Y, Kim S. Treatment of great auricular neuralgia with real-time ultrasound-guided great auricular nerve block: A case report and review of the literature. Medicine (Baltimore) 2017;96:e6325.
  3. Benton L, Trescot AM. Great Auricular/Posterior Auricular Nerve Entrapment. In: Trescot A.M. (eds) Peripheral Nerve Entrapments. Springer, Cham: 2016.
  4. Chiba M, Hirotani H, and Takahashi T. Clinical Features of Idiopathic Parotid Pain Triggered by the First Bite in Japanese Patients with Type 2 Diabetes: A Case Study of Nine Patients. Pain Res Treat 2018;2018: 7861451.
  5. Lieba-Samal D, Pivec C, Platzgummer H, et al. High-Resolution Ultrasound for Diagnostic Assessment of the Great Auricular Nerve--Normal and First Pathologic Findings. Ultraschall Med 2015;36:342–347.

Neha Sharma, MD, Windsor University SOM (Cayon, Saint Kitts and Nevis), and Faisal Khan MD, DABSM, DABPN, Consultant Neurologist, Sugarland Neurology and Sleep (Sugar Land, Texas)

Neha Sharma and Dr. Khan report no disclosures.