Glossopharyngeal neuralgia (GPN) is a rare condition that affects the glossopharyngeal nerve, which lies deep within the neck. GPN causes episodes of severe stabbing pain in the throat, tongue and ears. These excruciating bouts last anywhere from several seconds to a few minutes. Some people have multiple episodes in a day, others experience them every few days or weeks. The pain intensity and features of GPN are similar to that of trigeminal neuralgia, a nerve disorder affecting the face.
GPN is often caused by a blood vessel, tumor or other tissue compressing the glossopharyngeal nerve. In many cases, however, there is no clear cause. Most patients are in their 50s, although the condition can develop at any age.
Our approach to glossopharyngeal neuralgia
As one of the top neurology and neurosurgery programs in the country, UCSF has experts who specialize in evaluating and treating challenging and rare conditions, including glossopharyngeal neuralgia. Our team is experienced in both conventional and cutting-edge therapies shown to alleviate the pain of GPN. Patients with GPN are given high priority in scheduling an appointment to evaluate treatment options.
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Signs & symptoms
People with GPN experience brief episodes of severe shock-like pain in the back of the throat, back of the tongue or deep within the ear, usually just on one side of the head. Many patients find these bouts are triggered by a specific action, such as chewing, swallowing, yawning, clearing the throat, drinking cold liquids or sneezing.
A thorough history and physical exam are the first steps in determining whether you have GPN. A simple test that your doctor may perform is to lightly touch the back of your throat with a cotton swab. This maneuver often triggers pain in patients with GPN, while application of a local anesthetic (substance that numbs the area) can lessen the pain.
To confirm the diagnosis and determine whether you're a candidate for treatment, your doctor will order a contrast MRI scan. For this painless imaging test, you're injected with a harmless dye that interacts with the magnetic field emitted by the MRI machine; this creates detailed images that reveal whether a blood vessel, tumor or other tissue is compressing the glossopharyngeal nerve, causing your pain.
If you have GPN, treatment options include medications and surgical procedures. Either has the potential to reduce and even resolve the debilitating pain.
Our first-line treatment is medication. The drugs that work best at relieving GPN pain are anticonvulsant medications, such as carbamazepine (Tegretol), gabapentin (Neurontin), phenytoin (Dilantin), pregabalin (Lyrica), oxcarbazepine (Trileptal) and baclofen (Lioresal). If these medicines don't work, stop working or cause intolerable side effects, the next step is surgery.
The most common procedure is microvascular decompression, which is very effective at relieving the pain of GPN when the underlying problem is a blood vessel pressing on the nerve. In this procedure, the surgeon makes a small opening in the skull, moves the offending blood vessel away from the nerve, and places a small Teflon pad between the vessel and the nerve. Long-term pain relief is achieved for 80 percent of patients who undergo this surgery.
If our evaluation revealed no obvious nerve compression, we may perform a procedure that involves cutting the glossopharyngeal nerve and parts of the vagus nerve, which is the longest of the body's cranial nerves. This surgery can also provide patients with pain relief.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.