Glossopharyngeal Neuralgia (GPN)

What is glossopharyngeal neuralgia?

Glossopharyngeal neuralgia (GPN) is a rare condition that causes sudden episodes of pain in your tongue, throat, tonsils and ear. Irritation of the glossopharyngeal nerve causes symptoms that last a few seconds to minutes, but the pain can repeat many times throughout the day.

Your glossopharyngeal nerve is the ninth of 12 cranial nerves. You have two glossopharyngeal nerves, one on each side of your head. In most cases, GPN affects the nerve on one side of your head only.

You may feel pain when you eat, talk or laugh. Your throat may hurt when you sneeze or yawn. The activities you do without even thinking can be a major disruption in your day. Treatment options are available to help you manage how symptoms affect you.

Glossopharyngeal neuralgia is pronounced “GLOSS-oh-fair-en-GEE-ul” “new-RAL-juh.”

What are the types of glossopharyngeal neuralgia?

There are two types of glossopharyngeal neuralgia based on the cause:

• Primary glossopharyngeal neuralgia: It happens without an obvious cause. Your provider may refer to it as idiopathic glossopharyngeal neuralgia.
• Secondary glossopharyngeal neuralgia: This is when another condition or circumstance causes GPN.

What are the symptoms of glossopharyngeal neuralgia?

Pain is the main symptom of glossopharyngeal neuralgia. You might describe the pain as:

• Sharp.
• Stabbing.
• Shooting.
• Shocking.
• Aching.
• Burning.

The pain is usually intense and lasts a few seconds up to two minutes. It comes in bursts (known as episodes). Episodes can happen several times a day. You might wake up in the middle of the night in pain. This can go on for weeks or months. For many people, it can go away for a time and then return weeks, months or years later.

Glossopharyngeal neuralgia pain location

Glossopharyngeal neuralgia pain locations include:

• The back of your nose, mouth and throat (pharynx and nasopharynx), especially around your tonsils.
• Your throat around your voice box (larynx).
• Around and underneath your jaw and ears.
• The back of your tongue.

The pain affects multiple locations because your glossopharyngeal nerve connects to so many areas in your head, neck and face. Most cases only affect one side of your head.

In some cases, you may have radiating pain. This is pain that starts in one area and spreads to another. It can move between locations or extend to your shoulder and back.

What causes glossopharyngeal neuralgia?

Irritation of the glossopharyngeal nerve causes glossopharyngeal neuralgia. The most common causes include:

• Blood vessel compression.
• A growth, lesion or tumor.
• An infection.

Sometimes, healthcare providers aren’t sure what’s irritating this nerve. Other cases may have an underlying condition or circumstance that causes symptoms like:

• Autoimmune or inflammatory diseases like Sjögren’s syndrome.
• Brainstem lesion (damage).
• Demyelinating conditions like multiple sclerosis.
• Eagle syndrome.
• Physical trauma or an injury.
• Present at birth growth abnormalities.
• Schwannomas.
• Tongue carcinoma.

What triggers glossopharyngeal neuralgia?

The following activities may trigger glossopharyngeal neuralgia pain:

• Chewing.
• Coughing.
• Drinking cold beverages.
• Laughing.
• Sneezing.
• Swallowing.
• Talking.
• Touching your face or neck around and underneath your ears.
• Yawning.

Who is at risk of glossopharyngeal neuralgia?

Glossopharyngeal neuralgia can affect anyone at any age. It’s more common after age 50.

What are the complications of glossopharyngeal neuralgia?

Glossopharyngeal neuralgia usually doesn’t have serious complications unless it’s severe. GPN can make eating very painful, so you may be more prone to unintended weight loss.

When GPN is severe, it can also affect the nearby vagus nerve. The vagus nerve is part of your autonomic nervous system and carries signals that run many life-sustaining automatic body processes, including heart rate, blood pressure and breathing. GPN that also affects the vagus nerve can disrupt these automatic processes, causing:

• Irregular heart rhythms (arrhythmias).
• Slowed heart rate (bradycardia).
• Low blood pressure (hypotension).
• Fainting or passing out (syncope).
• Seizures.

In rare cases, GPN can affect your heart, slowing your heart rate or even causing cardiac arrest. Without immediate CPR and emergency medical care, cardiac arrest is almost always deadly.

How is glossopharyngeal neuralgia diagnosed?

A healthcare provider will diagnose glossopharyngeal neuralgia after a physical exam and testing. A diagnosis can take time because your provider is trying to figure out what’s causing your symptoms.

Tests to confirm a diagnosis include:

• Blood tests.
• CT scan.
• MRA scan.
• MRI.
• X-ray.

Your provider may gently touch the painful area with a cotton swab, and then use a local anesthetic and apply it to the same spot. If you feel pain when a provider touches the area and don’t feel pain after they apply the anesthetic, it could indicate GPN.

How is glossopharyngeal neuralgia treated?

Treatment for glossopharyngeal neuralgia may include:

• Taking medications: Medications reduce neuron (nerve cell) activity, which causes pain. Antiseizure medications like carbamazepine, gabapentin, oxcarbazepine or phenytoin are usually the first line of treatment. Baclofen and tricyclic antidepressants may also help.
• Applying a local anesthetic: You can apply a local anesthetic like lidocaine to the back of your throat to temporarily relieve pain.
• Nerve blocks: This involves injecting medication right around the problem nerve to prevent it from sending signals that cause pain.
• Surgery: A surgeon may perform a procedure to relieve pressure on a nerve (microvascular decompression) or cut specific nerve fibers that carry pain signals (rhizotomy) to prevent them from causing pain.

Your provider will work with you to determine what’s causing pain and find a treatment option that works best for you. They’ll also discuss any side effects to look out for.

Can this glossopharyngeal neuralgia be prevented?

Glossopharyngeal neuralgia almost always happens unpredictably. Many times, it happens for reasons that healthcare providers can’t find or explain. Because of this, you can’t prevent it and there’s no sure way to decrease your risk of developing it.

Does glossopharyngeal neuralgia go away?

Yes, glossopharyngeal neuralgia can — and often does — go away on its own. But it’s more likely to go away with treatment. Treatment methods are also often successful. When surgery is necessary, procedures may provide temporary or long-term pain relief.

How long does glossopharyngeal neuralgia last?

GPN is usually a temporary issue, lasting weeks or months. For most people with GPN, this only happens once in their lifetime.

However, some people experience a period of weeks or months with GPN symptoms. Then, they experience a longer period of symptom-free (remission), followed by a return of the symptoms. This cycle can alternate and happen over several years.

What is the life expectancy of someone with glossopharyngeal neuralgia?

Glossopharyngeal neuralgia doesn’t usually affect your life expectancy. The outlook for GPN is generally good. For most people, symptoms go away and never return.

The outlook tends to be poor if you have severe symptoms, especially pain on both sides of your head, constant pain and extremely severe pain. Symptoms like fainting and heart rhythm changes may increase the chances of a negative outcome.

When should I see my healthcare provider?

If you suspect you might have glossopharyngeal neuralgia because of pain in your face, mouth or neck, it’s important to see a healthcare provider. GPN is rare, but the nerves it involves are in a critical place in your head and neck. Knowing why it’s happening and treating it can help avoid future problems, some of which are dangerous.

If you have GPN, your healthcare provider will schedule follow-up visits. Seeing your provider when recommended can help track your symptoms and any changes in them, the effectiveness of treatments and more.

You should also see your provider if you notice:

• Your medications aren’t as effective as they were before.
• Your symptoms get worse.
• You have new symptoms.

When should I go to the emergency room?

Glossopharyngeal neuralgia usually isn’t an emergency unless it causes more severe symptoms. If you notice any of the following, you should get emergency medical care if you have GPN-like pain and any of the following:

• Dizzy spells or fainting that happen with specific actions, like yawning or talking.
• Unexplained fainting for any reason.
• Heart rate changes, especially irregular heart rhythms or heart palpitations.

What can mimic glossopharyngeal neuralgia?

Several conditions can mimic glossopharyngeal neuralgia. This means that they have similar symptoms or effects. They include:

• Trigeminal neuralgia.
• Jacobson’s neuralgia.
• Temporomandibular joint dysfunction disorders (TMJ).
• Other types of atypical face pain.