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Glossopharyngeal neuralgia

Glossopharyngeal neuralgia is a condition marked by repeated episodes of severe nerve pain in the tongue, throat, ear and tonsils, which can last a few seconds to a few minutes. The cause of the disorder is believed to be 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 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


Common 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, usually on one side, and may be severe. Episodes can occur many times each day and awaken the patient from sleep. Chewing, coughing, laughing, speaking and swallowing may trigger pain.

Diagnosis

Your doctor will perform tests to rule out problems, such as tumors, at the base of the skull. They may include:

  • CT scan of the head
  • MRI of the head
  • X-rays of the head or neck
  • Blood tests examining sugar level to look for causes of nerve damage


In some patients, the MRI scan will show swelling of the glossopharyngeal nerve.

To determine whether a blood vessel is pressing on the nerve, images 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, including 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 in a procedure called rhizotomy. Both surgeries are generally considered effective. If a cause of the neuralgia is found, we design the treatment to control the underlying problem.

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