Skip to content
How It Works
Explore
Ask a Question Resources Pricing
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Sign Up
PubMed This is a summary of 24 peer-reviewed journal articles Updated
Neurology

Can MS, Tumors, or Infections Cause Glossopharyngeal Pain?

At a Glance

Multiple sclerosis, tumors, and infections can rarely cause glossopharyngeal neuralgia, but most cases are not caused by these conditions. Constant pain, new weakness or numbness, swallowing or breathing problems, fever, weight loss, or a neck lump may prompt MRI or other targeted tests.

In this answer

3 sections

01

When to Seek Urgent Care

02

Potential Secondary Causes (Uncommon)

03

How Doctors Evaluate Your Symptoms

Yes, but this is uncommon. While glossopharyngeal neuralgia (GPN) is most often caused by a normal blood vessel pressing against the nerve, or has no identifiable cause at all, it can occasionally be “secondary” [1]. This means the neuralgic pain is a symptom of another underlying condition, such as a tumor, multiple sclerosis (MS), an infection, or a structural abnormality [2][3].

Hearing about conditions like cancer or MS can be frightening. It is important to remember that most people with GPN do not have these conditions. However, because treating a secondary cause requires a different approach, your doctor will look for specific warning signs to decide if further investigation is needed [4].

When to Seek Urgent Care

If you experience any of the following “red flag” symptoms along with your throat or ear pain, seek medical evaluation promptly:

  • Fainting, near-fainting, or a sudden drop in heart rate during an attack (a rare but serious complication of GPN)
  • Progressive difficulty swallowing, choking, or breathing problems
  • Unexplained weight loss, fever, night sweats, or a new lump in your neck
  • Constant, worsening pain rather than brief, shock-like attacks
  • New weakness, numbness, or changes in your voice (like severe hoarseness)

Potential Secondary Causes (Uncommon)

Tumors and Growths
Rarely, growths in the throat, neck, or skull base can compress the glossopharyngeal nerve (the cranial nerve responsible for feeling in the back of your throat and ear). Cancers of the oropharynx (throat) [2], the base of the tongue, and certain esophageal cancers [5] have been reported in medical case studies as causing GPN-like pain [6]. Benign (non-cancerous) tumors in the neck spaces can also compress the nerve [7]. Often, tumor-related pain is constant or accompanied by other nerve problems, rather than just classic GPN attacks.

Multiple Sclerosis (MS)
MS is a disease where the immune system damages myelin, the protective coating around nerves [8]. While it is very rare for MS to show up only as GPN [9], MS lesions in the brainstem (the lower part of the brain connected to the spinal cord) can affect the cranial nerve pathways [8].

Infections and Inflammatory Diseases
Certain infections and autoimmune conditions can occasionally irritate the nerve:

  • Shingles (Varicella-Zoster Virus): This virus can affect the cranial nerves, sometimes without causing a visible rash [10].
  • Local Infections: Severe chronic tonsillitis [11] or rare bone infections at the base of the skull [12] can inflame the nerve.
  • Inflammatory Conditions: Autoimmune diseases like vasculitis can cause inflammation of the tissues surrounding the brain, compressing nearby nerves [13].
  • Viral Triggers: Recent viral infections, such as COVID-19, have been noted in case reports as possible triggers, though these links are still being studied [14].

Vascular Malformations
Some patients have abnormal blood vessel structures, such as aneurysms (bulging vessels) [15] or arteriovenous fistulas (abnormal connections between arteries and veins) [16]. These can compress the lower cranial nerves.

Structural Mimics (Eagle Syndrome)
Eagle syndrome is an uncommon condition where a small bone in the skull (the styloid process) is abnormally long, or a nearby ligament is hardened [17]. When you move your head or swallow, these structures can affect adjacent tissues, causing pain that mimics GPN [3].

How Doctors Evaluate Your Symptoms

Diagnosis starts with a careful clinical examination to see if your pain pattern matches classic GPN. From there, your doctor will select tests based on your specific symptoms:

  • MRI Scans: An MRI of the brain is frequently used to look for causes like tumors, MS, or nerve compression [1]. A doctor might order special high-resolution views or use contrast dye if they suspect inflammation or a mass [18]. They might also order an MRA (to look at blood vessels) [15]. Keep in mind that seeing a blood vessel touching a nerve on an MRI is common and can be purely incidental—the imaging must match your symptoms [19].
  • ENT Evaluation: If you have throat symptoms, voice changes, or a neck mass, an Ear, Nose, and Throat (ENT) specialist may examine you [20]. They can use a small, flexible camera to look safely into your throat and vocal cords [21].
  • CT Scans: If a doctor suspects a bone issue like Eagle syndrome, a CT scan provides a much better view of bony structures than an MRI [22].
  • Laboratory and Spinal Fluid Tests: These are not routine. However, if your doctor sees signs of MS, infection, or widespread inflammation, they may order targeted blood tests [13] or, in rare cases, a lumbar puncture (spinal tap) to analyze your spinal fluid [23][10].
  • Biopsy: If an exam reveals a suspicious ulcer or mass, a small tissue sample will be taken to rule out cancer [24].

Common questions in this guide

Can multiple sclerosis cause glossopharyngeal neuralgia?
Yes, but it is very uncommon for multiple sclerosis to appear only as glossopharyngeal neuralgia. MS can damage myelin, the protective covering around nerves, and create lesions in the brainstem that affect glossopharyngeal nerve pathways. Other neurologic symptoms may lead a clinician to investigate this possibility.
Can a tumor or cancer cause glossopharyngeal neuralgia?
Rarely, a growth in the throat, neck, skull base, base of the tongue, or esophagus can press on or irritate the glossopharyngeal nerve. Tumor-related pain is often constant or accompanied by other nerve symptoms rather than typical brief, shock-like attacks. Most people with glossopharyngeal neuralgia do not have a tumor.
Can an infection cause glossopharyngeal nerve pain?
Yes, although this is uncommon. Shingles can affect cranial nerves even without a visible rash, and severe tonsillitis, a rare skull-base bone infection, inflammatory disease, or a recent viral illness such as COVID-19 has been reported as a possible trigger. The significance of these links varies, so fever or worsening symptoms should be assessed by a clinician.
What warning signs mean my glossopharyngeal pain needs prompt evaluation?
Seek prompt medical evaluation if an attack causes fainting or near-fainting, or if you have progressive trouble swallowing, choking, or breathing. Constant worsening pain, unexplained weight loss, fever, night sweats, a new neck lump, weakness or numbness, or a major voice change also warrants prompt assessment.
What tests are used to look for a secondary cause of glossopharyngeal neuralgia?
Evaluation usually starts with a clinical examination. An MRI of the brain and skull base, sometimes with contrast, may look for a tumor, MS-related changes, or nerve compression, while MR angiography examines blood vessels. An ENT examination, CT scan, targeted blood or spinal-fluid tests, and biopsy may be used when symptoms or imaging point to a specific problem.
If an MRI shows a blood vessel touching the glossopharyngeal nerve, does that prove it caused my pain?
No. Blood-vessel contact can occur in people who have no symptoms, so the imaging must match the pain pattern and examination findings. A clinician also considers whether the pain consists of brief, shock-like attacks and what triggers it.

Questions For You

Answer a question to get research tailored to you. Your answers are private.

Related questions

What Red Flags Suggest GPN, Throat Cancer, or Infection? Why Can Glossopharyngeal Neuralgia Feel Like Tooth Pain? Can Glossopharyngeal Neuralgia Ever Go Into Remission? Which Specialist Treats Glossopharyngeal Neuralgia? Glossopharyngeal Neuralgia Attack: What to Do at Home?
Show more
Can Glossopharyngeal Neuralgia Be Bilateral or Occur With TN? What Are the Criteria for Glossopharyngeal Neuralgia? Can GPN Cause Coughing, Choking, or a Hoarse Voice? What Else Triggers Glossopharyngeal Neuralgia Attacks? Can Giant Cell Arteritis Mimic Glossopharyngeal Neuralgia? Glossopharyngeal Neuralgia: Constant Pain Between Attacks? Classical, Idiopathic, or Secondary GPN: What's Different? How Can GPN Patients Prevent Dehydration and Weight Loss? Is It Safe to Drive, Work, Exercise, or Travel With GPN? Why Does Glossopharyngeal Neuralgia Cause Electric Pain? What Should I Track in a Glossopharyngeal Neuralgia Diary? Why Is Glossopharyngeal Neuralgia Rare and Misdiagnosed? Can Speech Therapy Help With Swallowing Problems in GPN? How Does GPN Affect Anxiety, Sleep, and Quality of Life?

Get notified when new evidence is published on Glossopharyngeal neuralgia.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What in my specific symptoms or physical exam makes you suspect—or not suspect—a secondary cause for my pain?
  2. 2.Would an MRI of my brain and skull base, with or without contrast, be helpful for my specific situation?
  3. 3.If my imaging shows a blood vessel touching a nerve, how do we determine if it is the actual cause or just an incidental finding?
  4. 4.Do my symptoms suggest I should be evaluated by an Ear, Nose, and Throat (ENT) specialist?
  5. 5.If my tests come back normal, what is our next step for managing the pain?

References

References (24)
  1. 1

    Imaging of Cranial Neuralgias.

    Kanekar S, Saif M, Kanekar S

    Neurologic clinics 2022; (40(3)):591-607 doi:10.1016/j.ncl.2022.02.008.

    PMID: 35871786
  2. 2

    Pulsed Radiofrequency Ablation for the Treatment of Glossopharyngeal Neuralgia Secondary to Oropharyngeal Carcinoma.

    Bharti N, Chattopadhyay S, Singla N, et al.

    Pain physician 2018; (21(3)):295-302.

    PMID: 29871374
  3. 3

    Pediatric glossopharyngeal neuralgia: a comprehensive review.

    Shereen R, Gardner B, Altafulla J, et al.

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2019; (35(3)):395-402 doi:10.1007/s00381-018-3995-3.

    PMID: 30361762
  4. 4

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

    Han A, Montgomery C, Zamora A, et al.

    Health psychology research 2022; (10(5)):36042 doi:10.52965/001c.36042.

    PMID: 35774913
  5. 5

    Glossopharyngeal Neuralgia with Syncope Caused by Recurrence of Esophageal Squamous Cell Carcinoma.

    Nagata K, Tajiri K, Ueda A, et al.

    Internal medicine (Tokyo, Japan) 2019; (58(7)):933-936 doi:10.2169/internalmedicine.1838-18.

    PMID: 30568145
  6. 6

    Case of vago-glossopharyngeal neuralgia secondary to metastatic oropharyngeal cancer.

    Whitman MA, Jefferson A, Pincelli T, Sanghavi DK

    BMJ case reports 2020; (13(6)) doi:10.1136/bcr-2019-232820.

    PMID: 32595127
  7. 7

    Glossopharyngeal schwannoma a rare case report: Diagnostic and surgical approach.

    Tawfeeq E, AlSaidan L, Hayat J, et al.

    International journal of surgery case reports 2023; (109()):108629 doi:10.1016/j.ijscr.2023.108629.

    PMID: 37557034
  8. 8

    Surgical Options for Cranial Nerve Functional Diseases.

    Broggi M, Maresca L, Mattioli L, et al.

    Advances and technical standards in neurosurgery 2026; (56()):309-333 doi:10.1007/978-3-032-22008-0_14.

    PMID: 42393453
  9. 9

    More Than Meets the Eye: Isolated Bilateral Abducens Nerve Palsy as the Initial Presentation of Multiple Sclerosis.

    Ojemolon PE, Enejo RE, Evbayekha EO, et al.

    Cureus 2022; (14(7)):e27176 doi:10.7759/cureus.27176.

    PMID: 36039209
  10. 10

    [Varicella-zoster virus infection with concomitant lower cranial polyneuropathy in the absence of fever, headache and meningeal signs].

    Murakami K, Kanzaki K, Kajimoto Y, Ito H

    Rinsho shinkeigaku = Clinical neurology 2023; (63(4)):225-230 doi:10.5692/clinicalneurol.cn-001818.

    PMID: 36990781
  11. 11

    Gradual aggravation of idiopathic glossopharyngeal neuralgia due to chronic tonsillitis: A case report.

    Kim E, Do W, Jung YH, et al.

    Medicine 2019; (98(17)):e15234 doi:10.1097/MD.0000000000015234.

    PMID: 31027070
  12. 12

    Primary or secondary otalgia-uncovering the mystery.

    Abshire M, Goyal A, Mankekar G

    BMJ case reports 2026; (19(8)) doi:10.1136/bcr-2026-273913.

    PMID: 42624637
  13. 13

    Garcin Syndrome in a Patient with Hypertrophic Pachymeningitis Following Otitis Media with Antineutrophil Cytoplasmic Antibody (ANCA)-associated Vasculitis (OMAAV).

    Nishimura N, Kawano S, Tamae A, Yoshizawa S

    Internal medicine (Tokyo, Japan) 2025; (64(11)):1756-1760 doi:10.2169/internalmedicine.4476-24.

    PMID: 39522993
  14. 14

    Glossopharyngeal Neuralgia Secondary to COVID-19: A Case Report.

    Nguyen BQ, Alaimo DJ

    Cureus 2022; (14(7)):e26817 doi:10.7759/cureus.26817.

    PMID: 35971353
  15. 15

    Bilateral Internal Carotid Artery Aneurysms at the Subpetrosal Portion with Unilateral Lower Cranial Nerve Palsies: Review and Consideration of Surgical Strategy.

    Noguchi K, Aoki T, Sakamoto R, et al.

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 2017; (26(4)):e55-e59 doi:10.1016/j.jstrokecerebrovasdis.2016.12.033.

    PMID: 28162904
  16. 16

    Posterior condylar canal dural arteriovenous fistula as a rare cause of glossopharyngeal neuralgia: A case report.

    Kim JH, Lee CY

    Headache 2021; (61(8)):1281-1285 doi:10.1111/head.14190.

    PMID: 34309850
  17. 17

    Eagle's Syndrome Managed Successfully by Pulsed Radiofrequency Treatment.

    Swain BP, Vidhya S, Kumar S

    Cureus 2020; (12(9)):e10574 doi:10.7759/cureus.10574.

    PMID: 33101818
  18. 18

    A woman in her forties with ear pain.

    Døving M, Stray A, Anandan S, et al.

    Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke 2024; (144(1)) doi:10.4045/tidsskr.23.0543.

    PMID: 38258718
  19. 19

    Classification of neurovascular compression in glossopharyngeal neuralgia: Three-dimensional visualization of the glossopharyngeal nerve.

    Tanrikulu L, Hastreiter P, Dörfler A, et al.

    Surgical neurology international 2015; (6()):189 doi:10.4103/2152-7806.172534.

    PMID: 26759734
  20. 20

    IgG4-related disease presenting as central skull base osteomyelitis with deep neck abscesses: A case report.

    Lee SH, Jaafar R, Misron NA, et al.

    Medicine 2025; (104(29)):e43351 doi:10.1097/MD.0000000000043351.

    PMID: 40696699
  21. 21

    Submandibular schwannoma: is excision a 'gold standard treatment'?

    Loterh SS, Prabhu V, O'Brien C

    BMJ case reports 2015; (2015()).

    PMID: 26272957
  22. 22

    Imaging of cranial nerves: a pictorial overview.

    Romano N, Federici M, Castaldi A

    Insights into imaging 2019; (10(1)):33 doi:10.1186/s13244-019-0719-5.

    PMID: 30877408
  23. 23

    Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.

    Thompson AJ, Banwell BL, Barkhof F, et al.

    The Lancet. Neurology 2018; (17(2)):162-173 doi:10.1016/S1474-4422(17)30470-2.

    PMID: 29275977
  24. 24

    Use of Selective Serotonin Reuptake Inhibitor and Midodrine in a Patient With Autonomic Instability 2/2 Compressive Squamous Cell Carcinoma and Pain.

    Ball K, Vacek TP

    Journal of investigative medicine high impact case reports 2018; (6()):2324709617749621 doi:10.1177/2324709617749621.

    PMID: 29404375

This page is for informational purposes only and does not constitute medical advice. A clinician should evaluate persistent glossopharyngeal pain or any warning signs.