13.1.2.1 Painful trigeminal neuropathy attributed to acute Herpes zoster

Description:
Unilateral head and/or facial pain of less than three months’ duration in the distribution of one or more branches of the trigeminal nerve, caused by and associated with other symptoms and/or clinical signs of acute Herpes zoster.

Diagnostic criteria:
A. Unilateral head and/or facial pain lasting <3 months and fulfilling criterion C
B. Either or both of the following:

    1. herpetic eruption has occurred in the territory of a trigeminal nerve branch or branches
    2. varicella zoster virus DNA has been detected in the CSF by polymerase chain reaction

C. Evidence of causation demonstrated by both of the following:

    1. pain preceded the herpetic eruption by <7 days
    2. pain is located in the distribution of the same trigeminal nerve branch or branches

D. Not better accounted for by another ICHD-3 diagnosis.

Comments:
Herpes zoster affects the trigeminal ganglion in 10-15% of cases, with the ophthalmic division being singled out in some 80% of patients. Rarely, pain is not followed by an eruption or rash (zoster sine herpete). The diagnosis in such cases is confirmed by polymerase chain reaction detection of varicella zoster virus DNA in the cerebrospinal fluid.

13.1.2.1 Painful trigeminal neuropathy attributed to acute Herpes zoster is usually burning, stabbing/shooting, tingling or aching, and accompanied by cutaneous allodynia.

Ophthalmic herpes may be associated with IIIrd, IVth and VIth cranial nerve palsies. Herpes zoster is common in immunocompromised patients, occurring in about 10% of those with lymphoma and 25% of patients with Hodgkin’s disease.