13.2 Glossopharyngeal neuralgia

Previously used term:
Vagoglossopharyngeal neuralgia.

Description:
A severe, transient, stabbing, unilateral pain experienced in the ear, base of the tongue, tonsillar fossa and/or beneath the angle of the jaw. It is commonly provoked by swallowing, talking and/or coughing, and may remit and relapse in the fashion of classical trigeminal neuralgia.

Diagnostic criteria:
A. At least three attacks of unilateral pain fulfilling criteria B and C
B. Pain is located in the posterior part of the tongue, tonsillar fossa, pharynx, beneath the angle of the lower jaw and/or in the ear
C. Pain has at least three of the following four characteristics:

    1. recurring in paroxysmal attacks lasting from a few seconds to 2 min
    2. severe intensity
    3. shooting, stabbing or sharp in quality
    4. precipitated by swallowing, coughing, talking or yawning

D. No clinically evident neurological deficit
E. Not better accounted for by another ICHD-3 diagnosis.

Comments:
13.2 Glossopharyngeal neuralgia is felt in the distributions of the auricular and pharyngeal branches of the vagus nerve as well as branches of the glossopharyngeal nerve. Prior to its development, unpleasant sensations can be experienced in affected areas for weeks to several months.

13.2 Glossopharyngeal neuralgia is less severe than 13.1.1 Classical trigeminal neuralgia but can be bad enough for patients to lose weight. These two disorders can occur together.

In rare cases, attacks of pain are associated with vagal symptoms such as cough, hoarseness, syncope and/or bradycardia. Some authors have proposed distinguishing between pharyngeal, otalgic and vagal subtypes of neuralgia, and suggested using the term vagoglossopharyngeal neuralgia when pain is accompanied by asystole, convulsions and syncope.

Imaging may show neurovascular compression of the glossopharyngeal nerve. There are single reports of secondary glossopharyngeal neuropathy caused by neck trauma, multiple sclerosis, tonsillar or regional tumours, cerebello-pontine angle tumours and Arnold-Chiari malformation.

13.2 Glossopharyngeal neuralgia is usually responsive, at least initially, to pharmacotherapy, especially antiepileptics. It has been suggested that application of local anaesthetic to the tonsil and pharyngeal wall can prevent attacks for a few hours.