Glossopharyngeal neuralgia
Glossopharyngeal neuralgia is a condition in which there are repeated episodes of severe pain in the tongue, throat, ear, and tonsils, which can last from a few seconds to a few minutes.
Causes
Glossopharyngeal neuralgia is believed to be caused by irritation of the ninth cranial nerve, called the glossopharyngeal nerve. Symptoms usually begin in people over age 40.
In most cases, the source of irritation is never found. Some possible causes for this type of nerve pain (neuralgia) are:
•Blood vessels pressing on the glossopharyngeal nerve
•Growths at the base of the skull pressing on the glossopharyngeal nerve
•Tumors or infections of the throat and mouth pressing on the glossopharyngeal nerve
Symptoms
Symptoms include severe pain in areas connected to the ninth cranial nerve:
•Back of the nose and throat (nasopharynx)
•Back of the tongue
•Ear
•Throat
•Tonsil area
•Voice box (larynx)
The pain occurs in episodes and may be severe. It is usually on one side, and feels jabbing. The episodes can occur many times each day, and awaken the person from sleep.
It can sometimes be triggered by:
•Chewing
•Coughing
•Laughing
•Speaking
•Swallowing
Exams and Tests
Tests will be done to identify problems, such as tumors, at the base of the skull. Tests may include:
•Blood tests (sugar level) to look for the causes of nerve damage
•CT scan of the head
•MRI of the head
•X-rays of the head or neck
Sometimes the MRI may show swelling (inflammation) of the glossopharyngeal nerve.
To find out whether a blood vessel is pressing on the nerve, pictures of the brain arteries may be taken using:
•Magnetic resonance angiography (MRA)
•CT angiogram
•X-rays of the arteries with a dye (conventional angiography)
Treatment
The goal of treatment is to control pain. Over-the-counter painkillers such as aspirin and acetaminophen (Tylenol) are not very effective for relieving glossopharyngeal neuralgia.
The most effective drugs are antiseizure medications. Antidepressants may help certain people.
In severe cases, when pain is difficult to treat, surgery to take pressure off the glossopharyngeal nerve may be needed. This is called microvascular decompression. Or, the nerve can be cut (rhizotomy). Both surgeries are generally considered effective. If a cause of the neuralgia is found, treatment should control the underlying problem.
Outlook (Prognosis)
How well you do depends on the cause of the problem and the effectiveness of the first treatment. Surgery is considered effective for people who do not benefit from medications.
Possible Complications
Slow pulse and fainting may occur when pain is severe.
Medications used to treat this condition can have side effects.
When to Contact a Medical Professional
Call your health care provider if you have symptoms of glossopharyngeal neuralgia. See a pain specialist if the pain is severe to be sure that you are aware of all your options for controlling pain.
Alternative Names
Cranial mononeuropathy IX; Weisenberg syndrome
References
Reddy GD, Viswanathan A. Trigeminal and glossopharyngeal neuralgia. Neurol Clin. 2014;32:539-52. PMID: 24703544 www.ncbi.nlm.nih.gov/pubmed/24703544.
Rucker JC. Cranial neuropathies. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 70.
Update Date 5/28/2014
Updated by: Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.