Face / Head / Neck

Glossopharyngeal Neuralgia

Glossopharyngeal neuralgia (GPN) is one of the cranial neuralgias and refers to a neuropathic pain syndrome in the ninth cranial nerve.

Aetiology

The cause of GPN is frequently unknown, but there is a relationship with trigeminal neuralgia and Eagle syndrome. The incidence is estimated to be 0.8/100,000 with a peak in patients of about 70 to 79 years old.  The left side is most frequently affected, with a bilateral occurrence in 2%.

Signs and symptoms

The pain attacks are characterised by serious and unbearable pain lasting a few seconds to minutes in the region of the rear-most pharynx, the tonsillar fossa and the base of the tongue. Frequently, irradiation to the outer auditory canal and neck is seen. Attacks are triggered by swallowing, cold drinks, sneezing, coughing, talking or clearing the throat.

Diagnostics

Physical Examination

General physical examination and neurological examination, in particular of the cranial nerves, are indicated in order to exclude other causes of secondary GPN.

In the differential diagnosis, intracranial tumours and vascular abnormalities must be considered.  Moreover, diseases such as Multiple Sclerosis, Paget's disease, tongue tumours, craniocervical malformations, Eagle Syndrome, and inflammatory processes such as Sjögren's disease, can result in secondary GPN.

Additional Somatic Diagnostics

Standard X-ray is not suitable. Depending on the clinical findings, additional examinations such as MRI and CT scans are indicated.

Additional Psycho-cognitive Diagnostics

  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

 

Pharmacological treatment:

  • Carbamazepine reduces the pain in 70% of cases.
  • Other anti-neuropathic pain medication can be used. However, there is no evidence of the efficacy of drugs such as gabapentine, pregabaline, amitriptyline and baclofen.

Other treatment