Glossopharyngeal neuralgia

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, such as carbamazepine, gabapentin, pregabalin, and phenytoin. Some antidepressants, such as amitriptyline or nortriptyline, 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

References

Cutrer FM, Moskowitz MA. Headaches and other head pain. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 421.

Ferroli P, Fioravanti A, Schiariti M, Tringali G, Franzini A, Calbucci F, Broggi G. Microvascular decompression for glossopharyngeal neuralgia: a long-term retrospective review of the Milan-Blogna experience in 31 consecutive cases. Acta Neuochir (Wien). 2009;151:1245-1250.

C. Gaul , P. Hastreiter, A. Duncker, and R. Naraghi. Diagnosis and neurosurgical treatment of glossopharyngeal neuralgia: clinical findings and 3-D visualization of neurovascular compression in 19 consecutive patients.  J Headache Pain. 2011; 12:527–534.

Update Date: 5/21/2012

Updated by: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network.Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.