Severe Bilateral Glossopharyngeal Neuralgia Managed With Nerve Blocks Following Plasmodium falciparum Malaria Infection Treated With Mefloquine

Abstract

BACKGROUND: The Internal Classification of Headache Disorders diagnosis for glossopharyngeal neuralgia (GN) includes recurrent paroxysmal severely painful attacks in the glossopharyngeal nerve distribution. Precipitating factors may be swallowing or talking, and diagnosis is made by exclusion. Conservative management includes medications, such as carbamazepine. For refractory cases, interventional nerve blocks may be required. CASE REPORT: A 38-year-old woman experienced severe bilateral GN and occipital neuralgia with atypical migraines after treatment with mefloquine for severe Plasmodium falciparum malaria. Symptoms included the inability to perform activities of daily living (ADLs) due to severe “electric sharp stabbing pain.” Following ineffective conservative management, she was successfully treated with a series of nerve blocks every 3 months. Over time, with repeated interventions, she acquired a significantly lower baseline of pain enabling her to participate in ADLs. CONCLUSIONS: This case report highlights nerve blocks as a viable treatment option for refractory bilateral GN following treatment with mefloquine. KEY WORDS: Glossopharyngeal neuralgia, malaria, plasmodium, falciparum, mefloquine, regional nerve blocks, stellate ganglion nerve block,glossopharyngeal nerve block