Glossopharyngeal & Other Cranial Neuralgias

When a different cranial nerve misfires

Several cranial nerves can develop the same kind of sudden, electric pain that the trigeminal nerve does. As with trigeminal neuralgia, the usual cause is a blood vessel pressing on the nerve where it leaves the brainstem.

• Glossopharyngeal neuralgia
  Stabbing pain deep in the throat, the base of the tongue, the tonsil, and the ear, typically triggered by swallowing, talking, coughing, or yawning. In rare cases an attack is accompanied by fainting or a slowed heartbeat, which makes prompt treatment important.
• Geniculate neuralgia (nervus intermedius)
  Deep, sharp pain often described as an "ice pick in the ear," sometimes spreading to the face around the eye or cheek.
• Superior laryngeal neuralgia
  Pain in the throat and voice box, sometimes radiating to the ear, in the territory of a branch of the vagus nerve.

After medication

As with trigeminal neuralgia, these are first treated with medication such as carbamazepine. Surgery is considered when the pain no longer responds, or when the medication needed is not tolerated. Because the symptoms can overlap with other conditions, careful evaluation, including imaging, comes first to confirm the diagnosis.

Surgical options

• Microvascular decompression (MVD)
  The same operation used for trigeminal neuralgia, applied to the affected nerve: the blood vessel pressing on it is moved away and cushioned, treating the cause while preserving the nerve's normal function.
• Nerve sectioning
  When decompression is not suitable, the small nerve (or the affected fibers) can be divided to stop the pain, an established option for glossopharyngeal and related neuralgias.

See also