Bolus of LR: Glossopharyngeal Neuralgia

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July 16, 2014 by dailybolusoflr

Glossopharyngeal neuralgia, also known as Vagoglossopharyngeal neuralgia is a less common neuralgia than Trigeminal Nnuralgia

What is it?


  • It is characterized by severe, intermittent and self limited, unilateral pain 
  • Location is typically the ear, base of the tongue and beneath the angle of the jaw
  • It is often triggered by eating, swallowing, coughing or talking, as well as by touching the skin in front of the ear, the side of the neck or the external auditory canal

Who gets it and why should you care?
  • It is most commonly seen in women and in patients over the age of 50
  • Most cases are idiopathic, however, cases may be caused by neurovascular compression and the evaluation should include imaging to evaluate this.  This does not need to be performed urgently in the ED, if it is not indicated by symptoms.
  • It can occur concurrently with trigeminal neuralgia, but patients with multiple involved nerves should have more urgent advanced imaging as they have a higher likelihood of having a structural lesion
  • It can also be associated with MS
  • Patients with severe disease can be unable to eat due to pain triggered by swallowing and may require supportive care


What to do?

  • Similar management to trigeminal neuralgia with use of medications for neuropathic pain such as carbamazepine, gabapentin, pregabalin etc
  • Referral to neurology and/or neurosurgery for further management which can include surgical options


References
Gradient P, Smith J. Curr Neurol Neurosci Rep (2014) 14:459
Warren HJ et al. AJNR March. (2006) 27: 705-70

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