What are the treatment options for glossopharyngeal neuralgia?

From the Guidelines

The treatment of glossopharyngeal neuralgia should begin with anticonvulsant medications, with the goal of reducing pain and improving quality of life, as management is similar to trigeminal neuralgia 1. The treatment options for glossopharyngeal neuralgia are focused on alleviating the severe, stabbing pain characteristic of the condition.

• Anticonvulsant medications are typically the first line of treatment, with the aim of reducing pain and improving quality of life.
• The choice of medication and dosage should be tailored to the individual patient, taking into account potential side effects and efficacy.
• In cases where medication therapy is ineffective or not tolerated, surgical interventions such as microvascular decompression or rhizotomy may be considered, as they can provide significant pain relief by addressing the underlying cause of the condition 1.
• Less invasive procedures like gamma knife radiosurgery or percutaneous radiofrequency thermocoagulation may also be options for patients who are poor surgical candidates, offering an alternative for those who cannot undergo more invasive surgeries. Key considerations in the treatment of glossopharyngeal neuralgia include:
• The potential for syncope due to anatomical proximity to the vagus nerve, which may influence the choice of treatment and monitoring of the patient 1.
• The importance of gradual dose escalation and monitoring for side effects when initiating anticonvulsant therapy.
• The need for a multidisciplinary approach, incorporating both medical and surgical options, to optimize patient outcomes and quality of life.

From the FDA Drug Label

Carbamazepine tablets are indicated in the treatment of the pain associated with true trigeminal neuralgia. Beneficial results have also been reported in glossopharyngeal neuralgia. Carbamazepine tablets are a prescription medicine used to treat: ... certain types of nerve pain (trigeminal and glossopharyngeal neuralgia)

Treatment options for glossopharyngeal neuralgia include:

• Carbamazepine tablets, which have been reported to have beneficial results in treating this condition 2, 2

From the Research

Treatment Options for Glossopharyngeal Neuralgia

The following treatment options are available for glossopharyngeal neuralgia:

• Medications:
  • Anticonvulsant drugs, especially carbamazepine, are the treatment of choice for glossopharyngeal neuralgia 3
  • Gabapentin can be used as an alternative for cases of carbamazepine failure 3, 4
• Surgical Treatment:
  • Microvascular decompression (MVD) is the first surgical option to consider when a neurovascular conflict on root entry zone (REZ) or cisternal portion of the ninth and tenth cranial nerves is identified 5, 6
  • Nerve section or decompression may be required if no clinical response is obtained from medical treatment 3
• Radiosurgery:
  • Gamma Knife radiosurgery is a non-invasive, efficacious treatment option for idiopathic glossopharyngeal neuralgia, offering short- and long-term relief without permanent complications 7
  • Gamma Knife radiosurgery can be an alternative option when a patient is ineligible for MVD 5
• Other Options:
  • Stereotactic radiosurgery has gained space in the treatment of selected cases of glossopharyngeal neuralgia 6
  • Radiofrequency rhizotomy can be used to manage recurrence after Gamma Knife radiosurgery 7