Glossopharyngeal neuralgia

• Alternative Names

  Cranial mononeuropathy IX

• Causes, incidence, and risk factors

  Glossopharyngeal neuralgia is believed to be caused by irritation of the ninth cranial 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 down on the glossopharyngeal nerve
  • Growths (lesions) at the base of the skull
  • Tumors or infections of the throat and mouth
• 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 can sometimes be triggered by:

  • Chewing
  • Coughing
  • Laughing
  • Speaking
  • Swallowing
• Signs and tests

  Tests will be done to identify problems, such as tumors, at the base of the skull. Tests may include:

  • CT scan of the head
  • MRI of the head
  • X-rays

  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)
  • X-rays of the arteries with a dye (conventional angiography)

  Certain blood tests may be needed when the diagnosis is not clear to rule out other causes of peripheral nerve problems (neuropathy), such as high blood sugar.

• Treatment

  The goal of treatment is to control pain. Over-the-counter pain killers such as aspirin and acetaminophen (Tylenol) are not very effective for the relief of neuralgia.

  The most effective drugs are antiseizure medications, such as carbamazepine, gabapentin, and phenytoin. Some antidepressants, such as amitriptyline, 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 surgery is generally considered effective. If a cause of the neuralgia is found, treatment should control the underlying problem.

• Expectations (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.

• Complications

  Slow pulse and fainting may occur when pain is severe.

  Medications used to treat this condition can have side effects.

• Calling your health care provider

  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.

Review Date: 2/6/2008

Reviewed By: Daniel Kantor, MD, Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.