What is the role of glossopharyngeal neuralgia in the etiology of facial pain and headache?

Updated: Jan 29, 2020
  • Author: Tejas Raval, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

This is a paroxysmal pain that originates in the tonsillar fossa or tongue base region. The pain can be provoked by swallowing, chewing, yawning, or talking. [31] Hypotension, bradycardia, or syncope can also occur. The etiology is thought to be from intracranial vascular compression of the ninth cranial nerve as it exits the medulla. Initial treatment consists of carbamazepine. [29]

In a retrospective study of 18 patients with glossopharyngeal neuralgia, Inoue et al classified the posterior inferior cerebellar arteries (PICAs), which are linked to the condition, into three categories. According to the report, type 1 PICAs form “an upward loop at the level of the glossopharyngeal nerve and [pass] between the glossopharyngeal and vestibulocochlear nerves.” The type 2 arteries are also characterized by an upward loop at the level of the glossopharyngeal nerve, but pass “between the glossopharyngeal and vagus nerves or between the rootlets of the vagus nerve.” Like the type 1 arteries, type 3 PICAs pass between the glossopharyngeal and vestibulocochlear nerves, but no loop is formed. In addition, the investigators reported that the anterior inferior cerebellar arteries (AICAs), which are also involved in glossopharyngeal neuralgia, displayed only a single running pattern. [34]


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