Glossopharyngeal Neuralgia

What is glossopharyngeal neuralgia?

Glossopharyngeal neuralgia (GPN) is pain caused by compression or irritation of the glossopharyngeal nerve that carries sensation from the tongue, throat, ear and tonsils to the brain. The pain is sharp and severe, usually affecting one side of the head, and lasts seconds to minutes. Eating, talking, laughing, sneezing or yawning can trigger attacks and disrupt daily life.

GPN is extremely rare. Although more common in people over 50, it can affect anyone. Many patients experience only a single episode, however, recurrent attacks may occur, often with symptom-free periods between episodes.

In many cases, it can be managed with medicine, while about 1 in 4 may need surgery. Pain on both sides, repeated episodes of very severe pain, or constant pain makes the condition more difficult to manage.

The term “glosso” refers to your tongue, “pharyngeal” refers to your throat, and “neuralgia” is pain caused by a damaged or irritated nerve.

Glossopharyngeal neuralgia (GPN) causes intense nerve pain when the glossopharyngeal nerve is irritated or compressed, and affects the tongue, throat, tonsils and ear.

GPN is usually temporary. Most cases affect only one side of the head. Pain episodes can last from a few seconds to a few minutes. It may occur only once, last for weeks or months, or recur over several years with pain-free periods in between episodes.

Types of glossopharyngeal neuralgia

There are two types of glossopharyngeal neuralgia:

• Primary or idiopathic glossopharyngeal neuralgia, when there is no apparent cause.
• Secondary glossopharyngeal neuralgia, when the GPN is caused by another health condition.

The glossopharyngeal nerve

The glossopharyngeal nerve is the ninth of 12 cranial nerves linking the brain to structures in the mouth and throat. You have two glossopharyngeal nerves, one on each side of your head. It supports sensation, muscle movement and involuntary functions, and serves the:

• Middle ear
• Salivary glands
• Carotid sinus
• Stylopharyngeus muscle, which connects to the voice box and pharynx
• Tongue
• Tonsils

In most cases, GPN only affects the nerve on one side of your head.

Causes

Glossopharyngeal neuralgia is caused when:

• A blood vessel presses on the glossopharyngeal nerve (the most common cause)
• A growth, lesion or tumour presses on the glossopharyngeal nerve
• Tumours or infections of the throat and mouth press on the glossopharyngeal nerve

There are cases where it’s caused by another medical condition like:

• Autoimmune or inflammatory diseases like Sjögren's syndrome
• Brainstem damage
• Multiple sclerosis
• Physical injury
• Schwannomas, a noncancerous nerve sheath tumour that develops from Schwann cells
• Cancer of the tongue

Sometimes, there’s no clear reason why the nerve is getting irritated.

Symptoms

The main symptom of glossopharyngeal neuralgia is severe pain in the areas connected to the glossopharyngeal nerve:

• Back of the nose and throat
• Back of the tongue
• Ear
• Throat
• Tonsil area
• Voice box (larynx)

The pain can be described as sharp, stabbing, shooting, shocking, aching or burning, and comes in bursts or episodes. Pain can last from a few seconds to a few minutes and can happen several times a day. It can go away for a period and return again.

Triggers

Several triggers can set off the pain, including:

• Chewing
• Coughing
• Laughing
• Speaking
• Swallowing
• Yawning
• Sneezing
• Cold drinks
• Touching

Risk factors

Glossopharyngeal neuralgia is more common in people over age 50 but it can affect anyone at any age.

How is glossopharyngeal neuralgia diagnosed?

Glossopharyngeal neuralgia is usually diagnosed from your description of the pain, including the type of pain, the location (to help identify whether the glossopharyngeal nerve is involved) and the triggers.

The following tests will also be used to confirm the diagnosis or identify an underlying cause:

• Blood tests to check for any infection or tumour
• CT scan of the head
• MRI of the head, which shows the swelling of the glossopharyngeal nerve
• X-rays of the head or neck

To determine whether a blood vessel is pressing on the nerve, images of the brain’s arteries may be taken using:

• Magnetic resonance angiography (MRA)
• CT angiogram
• X-rays of the arteries with a dye (conventional angiography)

What treatments are available for glossopharyngeal neuralgia?

Treatment of glossopharyngeal neuralgia is the same as trigeminal neuralgia. This includes:

• Medicine:
  • Antiseizure medicines are usually the first line of treatment, e.g. carbamazepine, gabapentin, oxcarbazepine or phenytoin
  • Muscle relaxants, e.g. baclofen
  • Tricyclic antidepressants
• Local anaesthetic: Applying a numbing medicine, such as lidocaine, to the back of the throat may provide short-term pain relief.
• Nerve blocks: Medicine is injected near the affected nerve to interrupt the pain signals it sends.
• Surgery:
  • Microvascular decompression, to ease the pressure on the nerve caused by a nearby blood vessel.
  • Rhizotomy, to stop pain signals by cutting selected nerve fibres.

What are the complications of glossopharyngeal neuralgia?

Without effective management, glossopharyngeal neuralgia can affect daily activities, emotional wellbeing and quality of life. People may experience:

• Slow pulse and/or fainting during a painful episode
• Difficulty swallowing or speaking
• Anxiety or fear of another pain episode
• Social withdrawal and isolation
• Side effects of the medicines
• Unintended weight loss because chewing and swallowing is painful

Severe GPN can affect the nearby vagus nerve, disrupting automatic functions such as heart rate, blood pressure and breathing.

In rare cases, it can slow the heart or even cause cardiac arrest, which requires urgent emergency care.

Prevention

Glossopharyngeal neuralgia can’t be prevented because it is often caused by factors such as pressure on the glossopharyngeal nerve or underlying medical conditions.

Living and managing

Understanding your triggers and working with your healthcare provider can help you manage daily life. Here are some tips:

• Because the glossopharyngeal nerve is highly sensitive, use a soft toothbrush and rinse with lukewarm rather than cold water; wash your face gently; avoid chewy, hard or crunchy foods; choose softer options such as mashed potato, smoothies and tender meat; avoid very hot or cold foods and drinks.
• If stress causes you to clench your jaw or grind your teeth, try relaxation techniques such as deep breathing, meditation or gentle yoga.
• Support groups may provide emotional support, practical advice, and opportunities to connect with others facing similar challenges.
• Some people report pain relief from complementary approaches such as acupuncture, aromatherapy, laser therapy, biofeedback or chiropractic treatment.
• Take medicines exactly as prescribed. Keep your healthcare provider updated on how well your treatment is working.