Glossopharyngeal neuralgia is severe, lancinating pain in the distribution of the glossopharyngeal and vagus nerves. The throat and base of the tongue are most commonly involved with possible radiation to the ear and sometimes to the neck. Salivation and coughing may occur. Triggers include swallowing, talking, and chewing. This is a rarer form of neuralgia, occurring 1 case for every 70 of trigeminal neuralgia. Anesthesia can be delivered using cocaine to the tonsillar pillars and fossa. Failure of relief is an indication for surgical intervention. Microvascular decompression (MVD) as detailed for trigeminal neuralgia is an option. An alternative is surgical sectioning of the glossopharyngeal nerve and upper one third or two fibers of the vagus nerve, whichever is larger via intracranial or extracranial approach. Dysphagia may occur but typically resolves spontaneously. As the vagus nerve is responsible for blood pressure regulation, cardiovascular complications are a serious complication of vagus nerve injury.