Glossopharyngeal neuralgia is an episodic and severe pain confined to the posterior tongue and throat of the Eustachian branch of the glossopharyngeal nerve or vagus nerve that radiates to the external ear. It is much less common than trigeminal neuralgia, with a ratio of 2:100, and is most common in middle-aged and elderly people. The cause of the disease is still unknown, but microvascular compression of the glossopharyngeal nerve may be the main cause. It is likely that microvascular compression of the linguopharyngeal and vagus nerves is the main cause. In terms of clinical symptoms, it is more common in men than in women, and the onset of the disease is usually after 35 years of age. The pain is confined to the area innervated by the glossopharyngeal nerve and the auricular and pharyngeal branches of the vagus nerve, namely the posterior pharyngeal wall, tonsillar fossa, root of the tongue and deep external auditory canal, and may radiate to the external ear, jaw and gingiva. The pain is usually unilateral, and only 2% of cases are bilateral. The pain is like a cut, pinprick, or electric shock, with sudden onset and intensity, lasting from a few seconds to a minute, and ranging from several to dozens of attacks per day. In most cases, there are distinct periods of flare-ups and periods of quiescence, sometimes lasting more than a year, but they do not resolve spontaneously. The pain is usually triggered by movements such as eating, swallowing, or speaking. About 10% of glossopharyngeal neuralgia is combined with trigeminal neuralgia. If the pain disappears by spraying the posterior pharyngeal wall or tonsillar area with 4% cocaine or 1% pontocaine, it can be differentiated from trigeminal mandibular branch pain. The diagnosis of glossopharyngeal neuralgia is mainly based on clinical manifestations and does not rely on imaging examinations. However, imaging tests, such as CT, MRI, DSA, etc., can help to distinguish primary from secondary glossopharyngeal neuralgia. Primary glossopharyngeal neuralgia is a case in which pain is triggered by compression of the root of the glossopharyngeal and vagus nerves by abnormal alignment vessels. Secondary glossopharyngeal neuralgia is pain caused by tumors in the oropharynx or pontocerebellar horn. Treatment principle of primary glossopharyngeal neuralgia: pharmacological treatment should be preferred after clear diagnosis, and non-pharmacological treatment should be used when pharmacological treatment is ineffective or obvious adverse drug reactions occur. Any drug used to treat primary trigeminal neuralgia can also be applied to this disease. Commonly used drugs include carbamazepine, phenytoinamide, heptaerythrone, baclofen, etc. Nerve block treatment: The method is percutaneous perforation of the jugular foramen for radiofrequency treatment, which is suitable for: 1. those who are ineffective in drug treatment or cannot tolerate adverse drug reactions; 2. those who are elderly or in poor general condition and cannot tolerate craniotomy; 3. cases with combined multiple sclerosis. The main problems of this treatment are the high recurrence rate of pain (23%-54%) and difficulty in swallowing, choking on water and hoarseness due to nerve damage. Microvascular decompression is currently the safest and most effective surgical treatment for primary glossopharyngeal neuralgia, while other surgical methods are less commonly used due to poor therapeutic results and surgical complications. Surgical treatment is suitable for: 1. patients who have failed in drug or percutaneous puncture treatment; 2. patients in good general condition, without serious organic lesions, who can tolerate surgery; 3. patients with lesions such as multiple sclerosis or pontocerebellar horn tumors are excluded. Most of the patients’ pain can disappear after surgery, and 92% of them can be cured. Microvascular decompression is to push away the blood vessels located in the root of the linguopharynx and vagus nerve that are abnormal and cause pressure on the linguopharynx and vagus nerve under the operating microscope, and fix them so that they do not touch the linguopharynx and vagus nerve, thus relieving the pressure of the blood vessels on the root of the linguopharynx and vagus nerve, restoring the normal function of the linguopharynx and vagus nerve, and relieving the pain symptoms. With the improvement of this surgery technology, especially its characteristics of minimally invasive, high safety, remarkable effect and low recurrence rate and complications, especially the ability to completely preserve the function of blood vessels and nerves, it is the most effective treatment method for linguopharyngeal neuralgia. The procedure is performed under general anesthesia and is painless for the patient. The incision is made in the hairline behind the affected ear, about 3-5 cm long, and a small hole of 1.5 cm in diameter is drilled in the skull.