Occipital, Geniculate & Glossopharyngeal Neuralgias
While trigeminal neuralgia is the most common of the facial pain diagnoses, there are others that cause facial pain. Understanding the various pain sensations and how they arise can help patients have better conversations with healthcare providers and look at different treatment options to best address the symptoms.
Of the conditions explored in this blog, occipital neuralgia is the most prevalent, whereas geniculate and glossopharyngeal neuralgia are rare facial pain disorders. All three should be differentiated from trigeminal neuralgia. However, the presence of one diagnosis does not exclude the possibility of another, making it important to bring up all your symptoms to your healthcare provider in order to help find the best pain management.
Occipital Neuralgia (ON)
The occipital nerve is not one of the cranial nerves, but rather a spinal nerve. However, it affects the head and face, which is why it is included in this facial pain blog.
The occipital nerve begins at the C2-C3 level, then reaches up behind the ear, goes above the hairline, and then runs throughout the scalp. There are three occipital nerves on each side: greater occipital nerve, third occipital nerve, and lesser occipital nerve.
What does it feel like?
Ever wondered what occipital neuralgia feels like? The classic presentation is severe, sharp, shock-like, piercing and/or throbbing pain in the upper neck, back of head and/or behind the ear. There may also be a dull aching pain between the shooting pain attacks.
What treatments are there?
These typically begin with ice/warm packs, then move to anti-inflammatories and muscle relaxants. The next steps would be medications typically used for neuropathic pain such as anticonvulsants and antidepressants, followed by nerve blocks, botox, and radiofrequency treatments. Surgical intervention is considered for refractory and non responsive patients who are in need of pain relief. There are three primary surgical interventions: decompression, neuromodulation, and neuro-destruction.
What are some of the triggers?
- Hair brushing
- Shampoo
- Tight neck muscles
NOTE: All other diagnoses should be ruled out before giving this diagnosis. Your healthcare provider may first test for chiari, osteoarthritis of the upper cervical spine, compression of the greater and/or lesser occipital nerves or C2 and/or C3 nerve roots from degenerative cervical spine changes, cervical disc disease, tumors affecting the C2 and C3 nerve roots, blood vessel inflammation, infection and other potential causes.
Geniculate Neuralgia (GN)
Geniculate differs from trigeminal neuralgia in that it doesn’t stem from a nerve, but rather a ganglion. The nervus intermedius is located between the facial nerve (cranial nerve VII) and the vestibulocochlear nerve (cranial nerve VIII).
What does it feel like?
The classic presentation of geniculate neuralgia is severe, sharp and deep ear pain. It is sometimes described as an “ice pick to the ear”. Atypical presentation would be constant dull and burning pain.
What treatments are there?
It is important to work with your healthcare provider because there are medications and treatments that have been successful in helping patients manage the pain better. Sodium channel blockers such as carbamazepine and oxcarbazepine are most commonly tried first, and some patients find success with MVD (microvascular decompression surgery).
What are some of the triggers?
- Stimulation of the ear canal
- Swallowing
- Talking
- Other facial nerve pain
NOTE: All other diagnoses should be ruled out before giving this diagnosis. Your healthcare provider will do a thorough evaluation of the eyes, ears, throat, nose and teeth, as well as evaluating patients for temporomandibular joint dysfunction and multiple sclerosis (if the symtoms develop before age 50).
Glossopharyngeal Neuralgia (GPN)
The glossopharyngeal nerve is the 9th cranial nerve. It is responsible for feeling in the tongue and throat and movements such as swallowing and the gag reflex. “Glosso-” means related to the tongue; “pharyngeal” means related to the pharynx, or throat.
What does it feel like?
The classic presentation is severe, sharp, recurrent pain in the ear, base of tongue, tonsils or beneath the angle of the jaw. It may shoot pain from the throat to the ear. An atypical presentation would be constant dull and burning pain in the same areas.
What treatments are there?
It is important to work with your healthcare provider, because there are medications and treatments that have been successful in helping patients manage better. Sodium channel blockers such as carbamazepine and oxcarbazepine are most commonly tried first. Some patients find success with MVD (microvascular decompression surgery) or the gamma knife. GPN nerve blocks can also be done and B12 is helpful for some patients.
What are some of the triggers?
- Swallowing
- Chewing
- Talking
- Sneezing
- Cold Liquids
- Clearing the throat
- Touching the area
- Sweet, spicy or sour foods
NOTE: It is important to exclude trigeminal neuralgia, inflammation, growths and multiple sclerosis, all of which can cause similar pain.
My pain is in the base of my neck. My face goes numb and my jaw line. The numbness and pins and needles goes into my head. When touch the top of my head I feel the sensitivity. I do have Lupus and my hair coming out from the scalp.
What can be wrong?
Thank you for this valuable information. I have had severe “head” pain , stabbing, burning and tenderness for well over 2 months now with no relief insite. It starts at base of my neck and spreads to back of both ears and up throughout the scalp. I am beside myself with discomfort and do not know what to do. This is as close as I have come to finding any information on diagnostic possibilities. An MRI did reveal all 7 cervical vertebrae with degenerative disease and stenosis in several. Ativan seems to alleviate some pain but I continue to search. Cold compresses also releives pain a bit.