Glossopharyngeal Neuralgia: Epidemiology, Risk factors, Pathophysiology, Differential diagnosis, and Treatment Options

Abstract

Purpose of Review This is a comprehensive review of the most recent literature on glossopharyngeal neuralgia (GPN), a relatively rare form of neuropathic facial pain. It covers the epidemiology, risk factors, pathophysiology, and differential diagnosis given that glossopharyngeal neuralgia can often be confused with other facial pain syndromes. Finally, we extensively review recent findings regarding medical or conservative measures, minimally invasive, and surgical options for potentially treating and managing glossopharyngeal neuralgia. Recent Findings An in-depth analysis of the recent literature indicates that glossopharyngeal neuralgia is not only rare but its etiology and pathophysiology are complex and are often secondary to other disease processes. Regardless, current management options are shown to be effective in controlling pain. Conservatively, first-line management of GPN is carbamazepine, but gabapentin and eslicarbazepine acetate are suitable alternatives. In terms of current minimally invasive pain management techniques, pulsed radiofrequency ablation, nerve blocks, or percutaneous radiofrequency thermocoagulation are effective. Finally, surgical management involves microvascular decompression and rhizotomy. Summary While there are currently many viable options for addressing glossopharyngeal neuralgia pain ranging from conservative to surgical management, the complex nature of GPN etiology, pathophysiology, and involved anatomical structures prompts further research for more effective ways to treat the disease.

A case of glossopharyngeal neuralgia successfully treated with levetiracetam

“…However, carbamazepine can induce severe side effects such as pancytopenia, toxic epidermal necrolysis, and interstitial pneumonia in rare cases [6]. Pregabalin, gabapentin [2], and eslicarbazepin [3] have been reported as alternatives to carbamazepine for glossopharyngeal neuralgia. We did not use pregabalin, which is available in Japan.…”

“…Glossopharyngeal neuralgia is a condition consisting of sore throat and pharyngeal pain that occurs in the area innervated by the glossopharyngeal nerve owing to vascular compression [1][2][3]. It is a relatively rare disease, with an incidence of 0.7 per 100,000 population per year [3]. The pain is triggered by coughing, talking, swallowing, or yawning.…”

“…Glossopharyngeal neuralgia is often accompanied by vagus nerve irritation, bradycardia, hypotension, and fainting spells. The pain is treated with carbamazepine [1][2][3][4] or oxycarbazepine [1,3], taken orally. Carbamazepine's side effects include lightheadedness, dizziness, toxic epidermal necrolysis, and interstitial pneumonia.…”

A Narrative Review on Pain Management in Head and Neck Cancer: Integrating Multimodal Analgesia and Interventional Procedures

“…It can occur following surgical interventions such as glossectomy. First-line pharmacological management involves the use of antiepileptic drugs, such as carbamazepine and gabapentin, to reduce neuronal excitability and dampen pain signals (8). However, in cases refractory to medical therapy, glossopharyngeal nerve block can provide targeted pain relief (9).…”

Long-Term Follow-Up of Ultrasound-Guided Glossopharyngeal Nerve Block Treatment for Glossopharyngeal Neuralgia: A Retrospective Clinical Study of 43 Cases

“…They can be triggered by swallowing, talking, coughing, chewing, or yawning but may also occur spontaneously with abrupt onset and termination. 1 , 2 Despite being a rare cause of craniofacial pain, representing only 0.2% to 1.3% of facial pain syndromes, GPN has an estimated overall incidence of 0.2 cases per 100,000 people each year 3 , 4 significantly impacting both the quality of life and socioeconomic functioning of patients. 5 The International Classification of Headache Disorders, 3rd edition, categorizes GPN into classical, secondary, and idiopathic types, 1 with classical GPN often being attributed to neurovascular compression, secondary GPN resulting from an underlying disease, and idiopathic GPN having an unknown etiology.…”