Clinical and physiopathological aspects of the glossopharyngeal neuralgia




Drug therapy, Glossopharyngeal nerve diseases, Microvascular decompression Surgery, Anticonvulsant, Carbamazepine, Differential diagnosis



Glossopharyngeal neuralgia is a rare syndrome characterized by paroxysms of unilateral and severe stabbing pain occurring in the nerve’s distribution. Although other neuralgias are well described in the medical literature, glossopharyngeal neuralgia and its physiopathology are not. The vascular compression at the nerve root entry zone is the primary explanation for the disease. The first-line treatment is pharmacological, including carbamazepine, oxcarbazepine, and gabapentin. Surgical treatment is offered to medication-refractory patients, and microvascular decompression surgery has the best outcomes.


To investigate the pathophysiological and clinical aspects of the different presentations of glossopharyngeal neuralgia.


A systematic review of the literature including case reports and clinical trials, was done.


A search of the literature yielded 31 papers that regarded glossopharyngeal neuralgia or its variants. Eight of these reports regarded vagoglossopharyngeal neuralgia. Seven regarded the glossopharyngeal neuralgia followed by or caused by another disease.


Glossopharyngeal neuralgia is a rare disease and requires further studies on its mechanism and clinical assessment; the physician needs to know how to distinguish it from its variants and underlying causes.


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The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013;33(9):629-808 Doi:10.1177/0333102413485658

Kawashima M, Matsushima T, Inoue T, Mineta T, Masuoka J and Hirakawa NJON. Microvascular decompression for glossopharyngeal neuralgia through the transcondylar fossa (supracondylar transjugular tubercle) approach. 2010;66(suppl_2):ons275-ons280 Doi:10.1227/

Matsushima T, Goto Y, Ishioka H, Mihara F and Fukui M. Possible role of an endovascular provocative test in the diagnosis of glossopharyngeal neuralgia as a vascular compression syndrome. Acta Neurochir (Wien) 1999;141(11):1229-1232 Doi:10.1007/s007010050423

Bruyn GW. Glossopharyngeal neuralgia. Cephalalgia 1983;3(3):143-157 Doi:10.1046/j.1468-2982.1983.0303143.x

Ferroli P, Fioravanti A, Schiariti M, Tringali G, Franzini A, Calbucci F and Broggi G. Microvascular decompression for glossopharyngeal neuralgia: a long-term retrospectic review of the Milan-Bologna experience in 31 consecutive cases. Acta Neurochir (Wien) 2009;151(10):1245-1250 Doi:10.1007/s00701-009-0330-5

Barbash GI, Keren G, Korczyn AD, Sharpless NS, Chayen M, Copperman Y and Laniado S. Mechanisms of syncope in glossopharyngeal neuralgia. Electroencephalogr Clin Neurophysiol 1986;63(3):231-235 Doi:10.1016/0013-4694(86)90089-1

Kandan SR, Khan S, Jeyaretna DS, Lhatoo S, Patel NK and Coakham HB. Neuralgia of the glossopharyngeal and vagal nerves: long-term outcome following surgical treatment and literature review. Br J Neurosurg 2010;24(4):441-446 Doi:10.3109/02688697.2010.487131

Kazemi B and Akbarzadeh F. Syncopal storm caused by glossopharyngeal neuralgia. Am J Emerg Med 2012;30(9):2101.e2105-2107 Doi:10.1016/j.ajem.2012.03.003

Korkes H, de Oliveira EM, Brollo L, Hachul DT, Andrade JC, Peres MF and Schubsky V. Cardiac syncope induced by glossopharyngeal "neuralgia": a rare presentation. Arq Bras Cardiol 2006;87(5):e189-191 Doi:10.1590/s0066-782x2006001800025

Lin HW, Rho MB, Amin-Hanjani S, Barker FG and Deschler DG. Glossopharyngeal and limited vagal neurectomy for cancer-related carotid sinus syncope. Skull Base 2009;19(5):369-373 Doi:10.1055/s-0029-1220204

Ozenci M, Karaoguz R, Conkbayir C, Altin T and Kanpolat Y. Glossopharyngeal neuralgia with cardiac syncope treated by glossopharyngeal rhizotomy and microvascular decompression. Europace 2003;5(2):149-152 Doi:10.1053/eupc.2002.0298

Saman Y, Whitehead D and Gleeson M. Jugular foramen schwannoma presenting with glossopharyngeal neuralgia syncope syndrome. J Laryngol Otol 2010;124(12):1305-1308 Doi:10.1017/s0022215110001556

Thiarawat P, Wangtheraprasert A and Jitprapaikulsan J. Vagoglossopharyngeal Neuralgia Occurred Concomitantly with Ipsilateral Hemifacial Spasm and Versive Seizure-Like Movement: A First Case Report. J Med Assoc Thai 2016;99(1):106-110

Guclu B, Sindou M, Meyronet D, Streichenberger N, Simon E and Mertens P. Cranial nerve vascular compression syndromes of the trigeminal, facial and vago-glossopharyngeal nerves: comparative anatomical study of the central myelin portion and transitional zone; correlations with incidences of corresponding hyperactive dysfunctional syndromes. Acta Neurochir (Wien) 2011;153(12):2365-2375 Doi:10.1007/s00701-011-1168-1

Bohm E and Strang RJB. Glossopharyngeal neuralgia. J Brain 1962;85(2):371-388 Doi:10.1093/brain/85.2.371

Rushton JG, Stevens JC and Miller RH. Glossopharyngeal (vagoglossopharyngeal) neuralgia: a study of 217 cases. Arch Neurol 1981;38(4):201-205 Doi:10.1001/archneur.1981.00510040027002

Singh PM, Dehran M, Mohan VK, Trikha A and Kaur M. Analgesic efficacy and safety of medical therapy alone vs combined medical therapy and extraoral glossopharyngeal nerve block in glossopharyngeal neuralgia. Pain Med 2013;14(1):93-102 Doi:10.1111/pme.12001

Soh KB. The glossopharyngeal nerve, glossopharyngeal neuralgia and the Eagle's syndrome--current concepts and management. Singapore Med J 1999;40(10):659-665

Thomson JL. Glossopharyngeal neuralgia accompanied by unconsciousness. J Neurosurg 1954;11(5):511-514 Doi:10.3171/jns.1954.11.5.0511

Kong Y, Heyman A, Entman ML and McIntosh HD. Glossopharyngeal neuralgia associated with bradycardia, syncope, and seizures. Circulation 1964;30(109-113 Doi:10.1161/01.cir.30.1.109

Acosta C and Clark K. Glossopharyngeal neuralgia associated with cardiac arrest. Case report. J Neurosurg 1970;32(6):706-707 Doi:10.3171/jns.1970.32.6.0706

St John JN. Glossopharyngeal neuralgia associated with syncope and seizures. Neurosurgery 1982;10(3):380-383 Doi:10.1227/00006123-198203000-00015

Ferrante L, Artico M, Nardacci B, Fraioli B, Cosentino F and Fortuna A. Glossopharyngeal neuralgia with cardiac syncope. Neurosurgery 1995;36(1):58-63; discussion 63 Doi:10.1227/00006123-199501000-00007

Wallin BG, Westerberg CE and Sundlöf G. Syncope induced by glossopharyngeal neuralgia: sympathetic outflow to muscle. Neurology 1984;34(4):522-524 Doi:10.1212/wnl.34.4.522

Esaki T, Osada H, Nakao Y, Yamamoto T, Maeda M, Miyazaki T, . . . Mori K. Surgical management for glossopharyngeal neuralgia associated with cardiac syncope: two case reports. Br J Neurosurg 2007;21(6):599-602 Doi:10.1080/02688690701627138

Reddy K, Hobson DE, Gomori A and Sutherland GR. Painless glossopharyngeal "neuralgia" with syncope: a case report and literature review. Neurosurgery 1987;21(6):916-919 Doi:10.1227/00006123-198712000-00023

Elias J, Kuniyoshi R, Carloni WV, Borges MR, Peixoto CA and Pimentel D. Glossopharyngeal neuralgia associated with cardiac syncope. Arq Bras Cardiol 2002;78(5):510-519 Doi:10.1590/s0066-782x2002000500008

Teixeira MJ, de Siqueira SR and Bor-Seng-Shu E. Glossopharyngeal neuralgia: neurosurgical treatment and differential diagnosis. Acta Neurochir (Wien) 2008;150(5):471-475; discussion 475 Doi:10.1007/s00701-007-1493-6

Graff-Radford SB, Newman A and Ananda AJT. Treatment options for glossopharyngeal neuralgia. 2005;2(5):733-737 Doi:10.1586/14750708.2.5.733

Katusic S, Williams DB, Beard CM, Bergstralh E and Kurland LT. Incidence and clinical features of glossopharyngeal neuralgia, Rochester, Minnesota, 1945-1984. Neuroepidemiology 1991;10(5-6):266-275 Doi:10.1159/000110283

Okur A, Ozkırış M, Serin HI, Gencer ZK, Karaçavuş S, Karaca L, . . . Saydam L. Is there a relationship between symptoms of patients and tomographic characteristics of styloid process? Surg Radiol Anat 2014;36(7):627-632 Doi:10.1007/s00276-013-1213-2

Slavin KV. Eagle syndrome: entrapment of the glossopharyngeal nerve? Case report and review of the literature. J Neurosurg 2002;97(1):216-218 Doi:10.3171/jns.2002.97.1.0216

Lenzi R, De Vito A, Dallan I and Muscatello L. MRI findings in a patient with glossopharyngeal neuralgia. Ear Nose Throat J 2010;89(5):210-212

Sampson JH, Grossi PM, Asaoka K and Fukushima T. Microvascular decompression for glossopharyngeal neuralgia: long-term effectiveness and complication avoidance. Neurosurgery 2004;54(4):884-889; discussion 889-890 Doi:10.1227/

Larsen A, Piepgras D, Chyatte D and Rizzolo D. Trigeminal neuralgia: diagnosis and medical and surgical management. Jaapa 2011;24(7):20-25 Doi:10.1097/01720610-201107000-00005

Taylor PH, Gray K, Bicknell PG and Rees JR. Glossopharyngeal neuralgia with syncope. J Laryngol Otol 1977;91(10):859-868 Doi:10.1017/s0022215100084486

Khero BA and Mullins CB. Cardiac syncope due to glossopharyngeal neuralgia. Treatment with a transvenous pacemaker. Arch Intern Med 1971;128(5):806-808

Jamshidi A and Masroor MA. Glossopharyngeal neuralgia with cardiac syncope: treatment with a permanent cardiac pacemaker and carbamazepine. Arch Intern Med 1976;136(7):843-845

Hupp WS and Firriolo FJ. Cranial neuralgias. Dent Clin North Am 2013;57(3):481-495 Doi:10.1016/j.cden.2013.04.009

Chua NH, Beems T and Vissers KC. Two cases of glossopharyngeal neuralgia successfully treated with pulsed radiofrequency treatment. Ann Acad Med Singap 2011;40(8):387-389

Peet MM. Glossopharyngeal neuralgia. Ann Surg 1935;101(1):256-268 Doi:10.1097/00000658-193501000-00026

Liu J, Shen Y, Jiang B, Yuan Y and Yu Y. Ameliorating Effect of Microvascular Decompression on Patients with Coexistence of Hemifacial Spasm and Glossopharyngeal Neuralgia: A Retrospective Study. World Neurosurg 2020;133(e62-e67 Doi:10.1016/j.wneu.2019.08.069

Obermann M and Katsarava Z. Update on trigeminal neuralgia. Expert Rev Neurother 2009;9(3):323-329 Doi:10.1586/14737175.9.3.323

Zhong J, Zhu J, Li ST and Guan HX. Microvascular decompressions in patients with coexistent hemifacial spasm and trigeminal neuralgia. Neurosurgery 2011;68(4):916-920; discussion 920 Doi:10.1227/NEU.0b013e318208f5ac

Spencer CJ and Gremillion HA. Neuropathic orofacial pain: proposed mechanisms, diagnosis, and treatment considerations. Dent Clin North Am 2007;51(1):209-224, viii Doi:10.1016/j.cden.2006.09.006

Papalexopoulou N, Hasegawa H, Selway R, Chong S and Ashkan K. The treatment of combined trigeminal and glossopharyngeal neuralgia by glycerol rhizolysis of the trigeminal ganglion. Br J Neurosurg 2015;29(1):92-93 Doi:10.3109/02688697.2014.957155

Montalbetti L, Ferrandi D, Pergami P and Savoldi F. Elongated styloid process and Eagle's syndrome. Cephalalgia 1995;15(2):80-93 Doi:10.1046/j.1468-2982.1995.015002080.x

Higuchi Y, Nashold BS, Jr., Sluijter M, Cosman E and Pearlstein RD. Exposure of the dorsal root ganglion in rats to pulsed radiofrequency currents activates dorsal horn lamina I and II neurons. Neurosurgery 2002;50(4):850-855; discussion 856 Doi:10.1097/00006123-200204000-00030

Shah RV and Racz GB. Pulsed mode radiofrequency lesioning to treat chronic post-tonsillectomy pain (secondary glossopharyngeal neuralgia). Pain Pract 2003;3(3):232-237 Doi:10.1046/j.1533-2500.2003.03028.x

Arias MJ. Percutaneous radio-frequency thermocoagulation with low temperature in the treatment of essential glossopharyngeal neuralgia. Surg Neurol 1986;25(1):94-96 Doi:10.1016/0090-3019(86)90124-2




How to Cite

Souza V, Passerini M, Sobral B, Baiardi V, Junior H. Clinical and physiopathological aspects of the glossopharyngeal neuralgia. HM [Internet]. 2021 Aug. 11 [cited 2022 Jan. 28];:5-11. Available from:




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