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

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.
1. Christoforou J. Neuropathic Orofacial Pain. Dental Clinics of North America. 2018;62(4):565-584. doi:10.1016/j.cden.2018.05.005
2. Khan M, Nishi SE, Hassan SN, Islam MA, Gan SH. Trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome: An update. Pain Research and Management. 2017;2017:1-18. doi:10.1155/2017/7438326
3. Benoliel R, Eliav E. Neuropathic Orofacial Pain. Oral and Maxillofacial Surgery Clinics of North America. 2008;20(2):237-254. doi:10.1016/j.coms.2007.12.001
4. Rutvij JS, Devang P. Glossopharyngeal Neuralgia - StatPearls - NCBI Bookshelf. StatPearls Publishing
5. Tepper SJ. Cranial Neuralgias. CONTINUUM: Lifelong Learning in Neurology. 2018;24(4):1157-1178. doi:10.1212/con.0000000000000637
6. Gadient PM, Smith JH. The neuralgias: Diagnosis and management. Curr Neurol Neurosci Rep. 2014;14(7):1-8. doi:10.1007/s11910-014-0459-3
7. Blumenfeld A, Nikolskaya G. Glossopharyngeal neuralgia. Curr Pain Headache Rep. 2013;17(7):1-8. doi:10.1007/s11916-013-0343-x
8. Chhabra A, Bajaj G, Wadhwa V, et al. MR neurographic evaluation of facial and neck pain: Normal and abnormal craniospinal nerves below the skull base. RadioGraphics. 2018;38(5):1498-1513. doi:10.1148/rg.2018170194
9. Ong CK, Chong VFH. The glossopharyngeal, vagus and spinal accessory nerves. European Journal of Radiology. 2010;74(2):359-367. doi:10.1016/j.ejrad.2009.05.064
10. Shah RJ, Padalia D. Glossopharyngeal Neuralgia. StatPearls Publishing
11. Shaefer JR, Nasir Khawaja S, Furlan Bavia P. Sex, Gender, and Orofacial Pain. Dental Clinics of North America. 2018;62(4):665-682. doi:10.1016/j.cden.2018.06.001
12. Teixeira MJ, De Siqueira SRDT, Bor-Seng-Shu E. Glossopharyngeal neuralgia: Neurosurgical treatment and differential diagnosis. Acta Neurochirurgica. 2008;150(5):471-475. doi:10.1007/s00701-007-1493-6
13. Glossopharyngeal Neuralgia | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program.
14. Agrawal SM, KDH. Trigeminal neuralgia involving supraorbital and infraorbital nerves. National Journal of Maxillofacial Surgery.
15. O’neill F, Nurmikko T, Sommer C. Other facial neuralgias. Cephalalgia. 2017;37(7):658-669. doi:10.1177/0333102417689995
16. O’neill F, Nurmikko T, Sommer C. Other facial neuralgias. Cephalalgia. 2017;37(7):658-669. doi:10.1177/0333102417689995
17. Singh M, Mukherji A, Vats A. A rare case of Charlin’s syndrome. J Indian Acad Oral Med Radiol. 2017;29(2):129. doi:10.4103/jiaomr.jiaomr_104_16
18. Temporal (Giant Cell) Arteritis. StatPearls - NCBI Bookshelf
19. Trigeminal Neuralgia Differential Diagnoses
20. Chen J, Sindou M. Vago-glossopharyngeal neuralgia: A literature review of neurosurgical experience. Acta Neurochir. 2015;157(2):311-321. doi:10.1007/s00701-014-2302-7
21. Christoforou J. Neuropathic Orofacial Pain. Dental Clinics of North America. 2018;62(4):565-584. doi:10.1016/j.cden.2018.05.005
22. Hupp WS, Firriolo FJ. Cranial Neuralgias. Dental Clinics of North America. 2013;57(3):481-495. doi:10.1016/j.cden.2013.04.009
23. Teixeira MJ, De Siqueira SRDT, Bor-Seng-Shu E. Glossopharyngeal neuralgia: Neurosurgical treatment and differential diagnosis. Acta Neurochir (Wien). 2008;150(5):471-475. doi:10.1007/s00701-007-1493-6
24. Shah RJ, Padalia D. Glossopharyngeal Neuralgia. Indian Journal of Otolaryngology. 2021;30(1):23-25.
25. Rushton JG, Stevens JC, Miller RH. Glossopharyngeal (Vagoglossopharyngeal) Neuralgia A Study of 217 Cases. Archives of Neurology. 1981;38(4):201-205. doi:10.1001/archneur.1981.00510040027002
26. Rozen TD. Trigeminal neuralgia andglossopharyngeal neuralgia. Neurologic Clinics. 2004;22(1):185-206. doi:10.1016/s0733-8619(03)00094-x
27. Deseure K, Hans GH. Differential drug effects on spontaneous and evoked pain behavior in a model of trigeminal neuropathic pain. Journal of Pain Research. 2017;10:279-286. doi:10.2147/jpr.s124526
28. Moretti R, Torre P, Antonello RM, Bava A, Cazzato G. Gabapentin treatment of glossopharyngeal neuralgia: A follow-up of four years of a single case. European Journal of Pain. 2002;6(5):403-407. doi:10.1016/s1090-3801(02)00026-5
29. A-Z Gaber TK, Myint Kyu M, Wah Oo W. Eslicarbazepine use in Multiple Sclerosis with refractory Trigeminal Neuralgaia. British Journal of Medical Practitioners. 2013;6(1).
30. García Arguedas C, Velázquez Benito A, Bellosta Adiego E, Suller Martí A, Camacho Velasquez JL, Pérez Lázaro C, et al. Eslicarbazepine acetate as an option for the treatment of neuropathic pain: A series of 10 cases. Neurology. 2014;29:213.
31. Alcántara Montero A, Sánchez Carnerero CI. Eslicarbazepine acetate for neuropathic pain, headache, and cranial neuralgia: Evidence and experience. Neurología. 2019;34(6):386-395. doi:10.1016/j.nrl.2016.11.009
32. Simpson CD, Rahman N, Lamey PJ. Glossopharyngeal neuralgia: a case report. British Journal of Oral and Maxillofacial Surgery. 2019;57(5):486-487. doi:10.1016/j.bjoms.2019.04.005
33. Blumenfeld A, Nikolskaya G. Glossopharyngeal Neuralgia. Curr Pain Headache Rep. 2013;17(7):1-8. doi:10.1007/s11916-013-0343-x
34. Dworkin RH, Backonja M, Rowbotham MC, et al. Advances in Neuropathic Pain Diagnosis, Mechanisms, and Treatment Recommendations. Arch Neurol. 2003;60(11):1524. doi:10.1001/archneur.60.11.1524
35. Jia Y, Shrestha N, Wang X, Wang T, Luo F. The long-term outcome of CT-guided pulsed radiofrequency in the treatment of idiopathic glossopharyngeal neuralgia: A retrospective multi-center case series. Journal of Pain Research. 2020;13:2093-2102. doi:10.2147/jpr.s259994
36. Bharti N, Professor D, Chattopadhyay S, et al. Pulsed Radiofrequency Ablation for the Treatment of Glossopharyngeal Neuralgia Secondary to Oropharyngeal Carcinoma. Pain Phys. 2018;21(1):295-301. doi:10.36076/ppj.2018.3.295
37. Liu Q, Zhong Q, Tang G, He G. Ultrasound-guided glossopharyngeal nerve block via the styloid process for glossopharyngeal neuralgia: A retrospective study. Journal of Pain Research. 2019;12:2503-2510. doi:10.2147/jpr.s214596
38. Schuster NM, Hsia-Kiung ME. Glossopharyngeal Postherpetic Neuralgia Palliated With Fluoroscopic-Guided Nerve Block: A Case Report. American Headache Society. 2018;58(1):154-156. doi:10.1111/head.13192
39. Wang X, Tang Y, Zeng Y, Ni J. Long-term outcomes of percutaneous radiofrequency thermocoagulation for glossopharyngeal neuralgia: A retrospective observational study. Medicine (United States). 2016;95(48):e5530. doi:10.1097/md.0000000000005530
40. Song L, He L, Pei Q, et al. CT-guided percutaneous radiofrequency thermocoagulation for glossopharyngeal neuralgia_ A retrospective clinical study of 117 cases | Elsevier Enhanced Reader. Clinical Neurology and Neurosurgery.
41. Xia L, Li YS, Liu MX, et al. Microvascular decompression for glossopharyngeal neuralgia: a retrospective analysis of 228 cases. Acta Neurochir. 2018;160(1):117-123. doi:10.1007/s00701-017-3347-1
42. He Z, Cheng H, Wu H, Sun G, Yuan J. Risk factors for postoperative delirium in patients undergoing microvascular decompression. PLoS ONE. 2019;14(4). doi:10.1371/journal.pone.0215374
43. Bartek J, Gulati S, Unsgård G, et al. Standardized reporting of adverse events after microvascular decompression of cranial nerves; a population-based single-institution consecutive series. Acta Neurochir. 2016;158(9):1775-1781. doi:10.1007/s00701-016-2856-7
44. Ma Y, Li YF, Wang QC, Huang HT. Neurosurgical treatment of glossopharyngeal neuralgia: analysis of 103 cases. J Neurosurg. 2016;124(4):1088-1092. doi:10.3171/2015.3.jns141806
45. Rui Y, Ji W, Chuncheng Q, Shengcheng W. Efficacy Comparison of Microvascular Decompression and Rhizotomy in the Treatment of Glossopharyngeal Neuralgia: A Retrospective Analysis of 37 Cases. Turkish Neurosurgery. 2019;29(4):493-496. doi:10.5137/1019-5149.jtn.23690-18.1
46. Funct S, Zheng X, Wei XY, et al. Clinical Study Microvascular Decompression Alone without Rhizotomy Is an Effective Way of Treating Glossopharyngeal Neuralgia: Clinical Analysis of 46 Cases. Stereotact Funct Neurosurg. 2020;98(2):129-135. doi:10.1159/000505712
47. Simpson CD, Rahman N, Lamey PJ. Glossopharyngeal neuralgia: a case report. British Journal of Oral and Maxillofacial Surgery. 2019;57(5):486-487. doi:10.1016/j.bjoms.2019.04.005