Painful trigeminal neuropathy attributed to herpes zoster


Unilateral facial pain of less than 3 months’ duration in the distribution(s) 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:
  1. Unilateral facial pain in the distribution(s) of a trigeminal nerve branch or branches, lasting <3 months
  2. One or more of the following:
    1. herpetic eruption has occurred in the same trigeminal distribution
    2. Varicella zoster virus (VZV) has been detected in the CSF by polymerase chain reaction (PCR)
    3. direct immunofluorescence assay for VZV antigen or PCR assay for VZV DNA is positive in cells obtained from the base of lesions
  3. Not better accounted for by another ICHD-3 diagnosis.

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

Ophthalmic herpes may be associated with IIIrd, IVth and/or 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.