Glossopharyngeal Neuralgia

Majority of cases of GPN are idiopathic.

Increased prevalence with extracranial neoplasms, trauma/infection/inflammation to tonsils, and pharynx, arachnoiditis.

More common in pts older than 50 y and middle-aged females.

Vagoglossopharyngeal neuralgia occurs in 10% of pts with GPN. Attacks of pain can trigger bradycardia/asystole, arterial hypotension, syncope, ECG changes (arrhythmias), or even cardiac arrest.

Tonic-clonic limb jerking and facial movements that resemble seizure activity can accompany attacks of pain.

Bradycardia, asystole, arterial hypotension, syncope, arrhythmias, and cardiac arrest during pain attacks

Drug interactions with anticonvulsants: Carbamazepine, phenytoin, and oxcarbazepine

Chronic narcotic use

Rare: Represents ∼1% of facial pain cases.

Sudden, sharp, and excruciating pain shooting to the pharynx, tonsil, base of tongue, with possible radiation to eustachian tube and inner ear structures and/or mandible angle.

Attacks may be triggered by swallowing (most common), chewing, talking, coughing, or yawning.

Paroxysms of pain are usually <1 min and can recur after brief periods.

Clusters of attacks last from weeks to months.

Trigger zones can be located when application of topical anesthetic solution relieves pain.

Pain typically stays on same side, and left side symptoms are more common (3:2).

Attacks can precipitate bradycardia, syncope, tachycardia, and arterial hypotension.

Cranial nerve (IX) receives afferent input from chemoreceptor and stretch baroreceptor of carotid body and carotid sinus, which may be responsible for CV reflex symptoms.

Differential Dx can include trigeminal neuralgia, superior laryngeal neuralgia, cluster headache, or sick sinus syndrome.