Occult tongue carcinoma and glossopharyngeal neuropathy: A rare cause of continuous hemicranial pain. A case report

Occult tongue carcinoma and glossopharyngeal neuropathy: A rare cause of continuous hemicranial pain. 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A case report Joe Munoz-Cerón, Sebastian Castro, Adriana Unigarro, Carlos Guerra This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3898627/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Most tongue tumor lesions are evident upon physical examination; however, in cases where this does not happen in such a way, it is possible that invasion to adjacent neural structures may occur, resulting in headache as an initial manifestation. Case presentation: We present the case of a 57-year-old man with continuous hemicranial pain, in whom further studies revealed occult tongue carcinoma as the cause of the headache. After treatment and two-year observation, the patient has remained asymptomatic. Conclusions: This report suggests considering the tongue as a potential source of secondary etiologies of persistent hemicranial headache and describes a clinical variant of known cause of glossopharyngeal neuropathy (13.2.2.1 in ICHD III). Neurology Secondary headache cancer neuralgia glossodynia Indomethacin test Figures Figure 1 Background Based on the International Headache Society, painful glossopharyngeal neuropathy presents as unilateral continuous or near-continuous pain with or without associated paroxysms (1). Although there are reports in the literature in which diverse etiologies have been documented, in these cases it is usual to describe symptoms and local lingual findings, factors that facilitate the early detection of the cause (2)(3)(4). To the best of our knowledge there are no reports describing neoplastic lesions of the tongue in which headache presents with the only clinical manifestation simulating a headache of primary origin. We reported a case in which a tongue squamous cell carcinoma was diagnosed in which continuous hemicranial pain was the exclusive manifestation, showing complete control of symptoms after surgery, chemotherapy, and radiotherapy. Clinical Presentation A 57-year-old man with a 5-month history of constant oppressive left hemicranial headache, without trigeminal autonomic signs, with daily periods of exacerbation lasting 2–6 hours, involving the submandibular cervical region and ipsilateral ear with no worsening or improving factors. No previous history of smoking, weight changes, or record of other types of headaches. Physical examination showed left pericranial tenderness without sensory alteration or visible lesions in the tongue or oral cavity, with bilateral gag reflex present. In spite of not finding trigeminal autonomic symptoms, the differential diagnosis included continuous hemicrania, for which reason a therapeutic test with Indomethacin was performed without improvement. Brain resonance, cervical spine with contrast, and neck ultrasound studies did not detect abnormalities. The evaluation by otorhinolaryngology and maxillofacial surgery ruled out other etiologies including asymmetry of the styloid processes and dysfunction of the temporomandibular joint. During the following four months he received symptomatic treatment with tramadol, pregabalin, NSAIDs, and pericranial blocks with lidocaine without response. In a new evaluation by a senior specialist in otorhinolaryngology, an area of induration was detected on palpation in the left dorsal posterior one third of the tongue, for which reason an MRI was performed on this structure, showing a lesion suggestive of a neoplastic process (Fig. 1 A). Hemiglossectomy was performed and the histopathological study showed infiltrating squamous cell carcinoma grade II (Fig. 1 B). After chemotherapy plus radiotherapy regimen and after 3-year follow-up, the patient remains pain free, without needing adjuvant analgesics. Discussion and Conclusion Although continuous hemicrania represents the main headache of primary origin, in the differential diagnosis of patients with unilateral continuous headache, it is mandatory, especially in case of indomethacin failure, to consider underlying etiologies ( 1 ). In this case, the unfavorable clinical course led to the exclusion of secondary intracranial and extracranial etiologies by conventional imaging methods of magnetic resonance and ultrasound without evidence of alterations. The determination of an underlying cause could be demonstrated only after detailed physical examination of the tongue and obtaining imaging studies targeted to this structure together with the corresponding histopathological studies. The squamous cell variety represents the most frequent type of tongue neoplasia and it presents more frequently in exophytic or ulcerated form ( 5 ), a characteristic that favors early detection after direct evaluation of the oral cavity; however, in cases of non-visible lesions, as in the case presented, it is possible to delay the diagnosis increasing the risk of disease progression to adjacent structures such as the glossopharyngeal nerve, which due to its anatomical distribution can cause hemicranial pain as the initial symptom, simulating a primary origin headache ( 6 ). This report highlights the importance of considering the tongue as a potential structure of localization of lesions causing unilateral cranial pain; some of these possibilities include neoplastic pathologies, which in early stages are only detectable through detailed physical examination and the use of specific imaging techniques that allow an accurate diagnostic approach. Considering that the cause of the headache was demonstrated in relation to invasion of the glossopharyngeal nerve associated with neoplastic lesion and that complete control of the symptoms was evidenced after treating the underlying cause, this case corresponds to painful glossopharyngeal neuropathy of known cause (13.2.2.1 in ICHD III) due to neoplastic lesion of the tongue, Table 1. ( 1 ) Unilateral continuous or near-continuous pain 1 in the distribution of the glossopharyngeal nerve and fulfilling criterion C B. A disorder known to be able to cause painful glossopharyngeal neuropathy has been diagnosed C. Evidence of causation demonstrated by both of the following: 1. pain is ipsilateral to the glossopharyngeal nerve affected by the disorder 2. pain has developed after onset of the disorder, or led to its discovery D. Not better accounted for by another ICHD-3 diagnosis. _______________________________________ Table 1. Diagnostic criteria ICHD 3, Painful glossopharyngeal neuropathy attributed to a known cause Clinical implications In cases of persistent hemicranial pain with radiation to the ear and submandibular region it is possible to consider the tongue as a potential location of structural lesions causing pain. Squamous cell carcinoma represents a differential diagnosis in the study of non-exophytic tongue lesions. An Indomethacin test performed without improvement should raise other differential diagnoses in the study of persistent hemicranial pain. Declarations Author contributions Dr Joe Munoz-Cerón summarized and analyzed the data and was a major contributor to writing the manuscript. Dr Castro, Dr Guerra and Dr Unigarro reviewed the case report and were major contributors to the manuscript. Ethics approval and consent to participate This report was approved by the Medical Ethic Committee of Rosario University (DVO 1179 CV1252). All information has been appropriately deidentified. Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Declaration of conflicting interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors received financial support for the translation and publication of this article from Hospital Universitario Mayor Méderi Availability of data and material Not applicable References 1. Headache classification committee of the international headache society (IHS) the international classification of headache disorders, 3rd edition. Cephalalgia: An International Journal of Headache , 2018; 38 :1–211. https://doi.org/10.1177/0333102417738202 2.Urban, P. P., Keilmann, A., Teichmann, E. M., & Hopf, H. C. Sensory neuropathy of the trigeminal, glossopharyngeal, and vagal nerves in Sjögren’s syndrome. Journal of the Neurological Sciences , 2001; 186 :59–63. https://doi.org/10.1016/s0022-510x(01)00501-9 3.Kohli, D., Katzmann, G., & Ananthan, S. Glossopharyngeal neuropathy. Journal of the American Dental Association . 2021; 152 : 245–249. https://doi.org/10.1016/j.esmoop.2020.04.024 4.Hamilton, K. T., Seligman, R., Blue, R., & Lee, J. Y. K. Refractory glossopharyngeal neuralgia successfully treated with onabotulinumtoxinA: A case report. Headache , 2022; 62 : 1424–1428. https://doi.org/10.1111/head.14421 5.Khalesi, S., Abbasi, A., & Razavi, S. M. Evaluating the Clinicopathologic Parameters of Tongue Squamous Cell Carcinoma based on its Local Distribution. Adv Biomed Res. 2023; 12:71. 6.Park, J. S., & Ahn, Y. H. Glossopharyngeal neuralgia. Journal of Korean Neurosurgical Society , 2022; 66 : 12–23. https://doi.org/10.3340/jkns.2022.0178 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3898627","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":269339468,"identity":"8f01e3e2-53d7-40cf-b0a2-ec5e75759498","order_by":0,"name":"Joe Munoz-Cerón","email":"","orcid":"https://orcid.org/0000-0002-3318-9351","institution":"Hospital Universitario Mayor Mederi - Universidad del Rosario","correspondingAuthor":false,"prefix":"","firstName":"Joe","middleName":"","lastName":"Munoz-Cerón","suffix":""},{"id":269339469,"identity":"bb0f0c11-ce8c-4607-bd5b-e4b28a208614","order_by":1,"name":"Sebastian Castro","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBACxgYYix3EKgDiA0RpSQBiHpBSAyK0QABIi0QCkVqY+w8//Pjzxz05+ZlvzB78MGCQ47uRwPjhAz6HzUgzluZJKDY2uJ1jbthjwGAseSOBWXIGXi08DNIMCQmJG6RzzCR4DBgSN9xIYGPmwael/wzzzx9ALfNnnjGT/GPAUE9YS0MOmwQPUEvDDR4zaaAtCQYEtcxIM7PmSUswNjiTViYtYyBhOPPMw2a8fjHsP/z45g+bBDn59sPbJN9U2MjzHU8+iDfEDBtQ+RIMyCkCK5DHKzsKRsEoGAWjAAQABNhIHjmXe6gAAAAASUVORK5CYII=","orcid":"https://orcid.org/0009-0003-1361-4757","institution":"Hospital Universitario Mayor Mederi - Universidad del Rosario","correspondingAuthor":true,"prefix":"","firstName":"Sebastian","middleName":"","lastName":"Castro","suffix":""},{"id":269339470,"identity":"acf79a46-78e1-451f-bcc5-07ddeadf76f1","order_by":2,"name":"Adriana Unigarro","email":"","orcid":"","institution":"Clínica Universitaria Colombia Fundación Universitaria Sanitas","correspondingAuthor":false,"prefix":"","firstName":"Adriana","middleName":"","lastName":"Unigarro","suffix":""},{"id":269339471,"identity":"03097d48-dbaa-43d5-9ca8-fc73f15f6075","order_by":3,"name":"Carlos Guerra","email":"","orcid":"","institution":"Clínica Universitaria Colombia Fundación Universitaria Sanitas","correspondingAuthor":false,"prefix":"","firstName":"Carlos","middleName":"","lastName":"Guerra","suffix":""}],"badges":[],"createdAt":"2024-01-26 00:30:29","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-3898627/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3898627/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50330087,"identity":"4d571f40-9031-4a7e-8d33-7d741d971f48","added_by":"auto","created_at":"2024-01-29 21:36:13","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":151610,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e1A.\u003c/strong\u003e MRI Sagittal T1+C fat sat. Ilidefine \u003cem\u003e(sic)\u003c/em\u003e and heterogeneously enhancing mass in the posterior left tongue, infiltrates mylohyoid \u0026nbsp;and genioglossus muscles (yellow arrow). \u0026nbsp;\u0026nbsp;\u003cstrong\u003e1B.\u003c/strong\u003e HE stain, infiltrating squamous cell carcinoma, moderately differentiated from large cell, GRADE 2, nonkeratinizing with lymphatic and perineural vascular invasion, P16 positive 95%.\u003c/p\u003e","description":"","filename":"ARTCEFALEA.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3898627/v1/51fba0dc8c85a1c5fddbb57b.jpg"},{"id":50330089,"identity":"aa097beb-59ac-4188-b441-eca230c7f945","added_by":"auto","created_at":"2024-01-29 21:36:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":285347,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3898627/v1/e918b2e1-d715-4f12-bb8d-26c92ee33e48.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eOccult tongue carcinoma and glossopharyngeal neuropathy: A rare cause of continuous hemicranial pain. A case report\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eBased on the International Headache Society, painful glossopharyngeal neuropathy presents as unilateral continuous or near-continuous pain with or without associated paroxysms (1). Although there are reports in the literature in which diverse etiologies have been documented, in these cases it is usual to describe symptoms and local lingual findings, factors that facilitate the early detection of the cause (2)(3)(4). To the best of our knowledge there are no reports describing neoplastic lesions of the tongue in which headache presents with the only clinical manifestation simulating a headache of primary origin.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe reported a case in which a tongue squamous cell carcinoma was diagnosed in which continuous hemicranial pain was the exclusive manifestation, showing complete control of symptoms after surgery, chemotherapy, and radiotherapy.\u0026nbsp;\u003c/p\u003e"},{"header":"Clinical Presentation","content":"\u003cp\u003eA 57-year-old man with a 5-month history of constant oppressive left hemicranial headache, without trigeminal autonomic signs, with daily periods of exacerbation lasting 2–6 hours, involving the submandibular cervical region and ipsilateral ear with no worsening or improving factors. No previous history of smoking, weight changes, or record of other types of headaches. Physical examination showed left pericranial tenderness without sensory alteration or visible lesions in the tongue or oral cavity, with bilateral gag reflex present. In spite of not finding trigeminal autonomic symptoms, the differential diagnosis included continuous hemicrania, for which reason a therapeutic test with Indomethacin was performed without improvement. Brain resonance, cervical spine with contrast, and neck ultrasound studies did not detect abnormalities. The evaluation by otorhinolaryngology and maxillofacial surgery ruled out other etiologies including asymmetry of the styloid processes and dysfunction of the temporomandibular joint. During the following four months he received symptomatic treatment with tramadol, pregabalin, NSAIDs, and pericranial blocks with lidocaine without response. In a new evaluation by a senior specialist in otorhinolaryngology, an area of induration was detected on palpation in the left dorsal posterior one third of the tongue, for which reason an MRI was performed on this structure, showing a lesion suggestive of a neoplastic process (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). Hemiglossectomy was performed and the histopathological study showed infiltrating squamous cell carcinoma grade II (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). After chemotherapy plus radiotherapy regimen and after 3-year follow-up, the patient remains pain free, without needing adjuvant analgesics.\u003c/p\u003e"},{"header":"Discussion and Conclusion","content":"\u003cp\u003eAlthough continuous hemicrania represents the main headache of primary origin, in the differential diagnosis of patients with unilateral continuous headache, it is mandatory, especially in case of indomethacin failure, to consider underlying etiologies (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In this case, the unfavorable clinical course led to the exclusion of secondary intracranial and extracranial etiologies by conventional imaging methods of magnetic resonance and ultrasound without evidence of alterations. The determination of an underlying cause could be demonstrated only after detailed physical examination of the tongue and obtaining imaging studies targeted to this structure together with the corresponding histopathological studies.\u003c/p\u003e\u003cp\u003eThe squamous cell variety represents the most frequent type of tongue neoplasia and it presents more frequently in exophytic or ulcerated form (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), a characteristic that favors early detection after direct evaluation of the oral cavity; however, in cases of non-visible lesions, as in the case presented, it is possible to delay the diagnosis increasing the risk of disease progression to adjacent structures such as the glossopharyngeal nerve, which due to its anatomical distribution can cause hemicranial pain as the initial symptom, simulating a primary origin headache (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis report highlights the importance of considering the tongue as a potential structure of localization of lesions causing unilateral cranial pain; some of these possibilities include neoplastic pathologies, which in early stages are only detectable through detailed physical examination and the use of specific imaging techniques that allow an accurate diagnostic approach.\u003c/p\u003e\u003cp\u003eConsidering that the cause of the headache was demonstrated in relation to invasion of the glossopharyngeal nerve associated with neoplastic lesion and that complete control of the symptoms was evidenced after treating the underlying cause, this case corresponds to painful glossopharyngeal neuropathy of known cause (13.2.2.1 in ICHD III) due to neoplastic lesion of the tongue, Table\u0026nbsp;1. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cdiv style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\n \u003col start=\"1\" style=\"margin-bottom:0in;list-style-type: upper-alpha;margin-left:124.6px;\"\u003e\n \u003cli style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;font-size:11.0pt;'\u003eUnilateral continuous or near-continuous pain 1 in\u003c/span\u003e\u003c/li\u003e\n \u003c/ol\u003e\n\u003c/div\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003ethe distribution of the glossopharyngeal nerve and\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003efulfilling criterion C\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eB. A disorder known to be able to cause\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003epainful glossopharyngeal neuropathy has been\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003ediagnosed\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eC. Evidence of causation demonstrated by both of\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003ethe following:\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e1. pain is ipsilateral to the glossopharyngeal\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003enerve affected by the disorder\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e2. pain has developed after onset of the disorder,\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eor led to its discovery\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eD. Not better accounted for by another ICHD-3\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-indent:113.35pt;line-height:200%;'\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003ediagnosis.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;'\u003e\u003cspan style='font-size:15px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;_______________________________________\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:1.0in;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eTable 1. Diagnostic criteria ICHD 3,\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003ePainful glossopharyngeal\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:.5in;text-indent:.5in;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003eneuropathy attributed to a known cause\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical implications\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eIn cases of persistent hemicranial pain with radiation to the ear and submandibular region it is possible to consider the tongue as a potential location of structural lesions causing pain.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSquamous cell carcinoma represents a differential diagnosis in the study of non-exophytic tongue lesions.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAn Indomethacin test performed without improvement should raise other differential diagnoses in the study of persistent hemicranial pain.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr Joe Munoz-Cer\u0026oacute;n summarized and analyzed the data and was a major contributor to writing the manuscript. Dr Castro, Dr Guerra and Dr Unigarro reviewed the case report and were major contributors to the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis report was approved by the Medical Ethic Committee of Rosario University (DVO 1179 CV1252).\u0026nbsp;All information has been appropriately deidentified.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of conflicting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received financial support for the translation and publication of this article from Hospital Universitario Mayor M\u0026eacute;deri\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Headache classification committee of the international headache society (IHS) the international classification of headache disorders, 3rd edition. \u003cem\u003eCephalalgia: An International Journal of Headache\u003c/em\u003e, 2018;\u003cem\u003e38\u003c/em\u003e:1\u0026ndash;211.\u0026nbsp;\u003ca href=\"https://doi.org/10.1177/0333102417738202\"\u003ehttps://doi.org/10.1177/0333102417738202\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e2.Urban, P. P., Keilmann, A., Teichmann, E. M., \u0026amp; Hopf, H. C. Sensory neuropathy of the trigeminal, glossopharyngeal, and vagal nerves in Sj\u0026ouml;gren\u0026rsquo;s syndrome. \u003cem\u003eJournal of the Neurological Sciences\u003c/em\u003e, 2001;\u003cem\u003e186\u003c/em\u003e:59\u0026ndash;63.\u0026nbsp;\u003ca href=\"https://doi.org/10.1016/s0022-510x(01)00501-9\"\u003ehttps://doi.org/10.1016/s0022-510x(01)00501-9\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e3.Kohli, D., Katzmann, G., \u0026amp; Ananthan, S. Glossopharyngeal neuropathy. \u003cem\u003eJournal of the American Dental Association\u003c/em\u003e. 2021; \u003cem\u003e152\u003c/em\u003e: 245\u0026ndash;249. https://doi.org/10.1016/j.esmoop.2020.04.024\u003c/p\u003e\n\u003cp\u003e4.Hamilton, K. T., Seligman, R., Blue, R., \u0026amp; Lee, J. Y. K. Refractory glossopharyngeal neuralgia successfully treated with onabotulinumtoxinA: A case report. \u003cem\u003eHeadache\u003c/em\u003e, 2022;\u003cem\u003e62\u003c/em\u003e: 1424\u0026ndash;1428. \u0026nbsp;https://doi.org/10.1111/head.14421\u003c/p\u003e\n\u003cp\u003e5.Khalesi, S., Abbasi, A., \u0026amp; Razavi, S. M. Evaluating the Clinicopathologic Parameters of Tongue Squamous Cell Carcinoma based on its Local Distribution.\u0026nbsp;Adv Biomed Res. 2023; 12:71.\u003c/p\u003e\n\u003cp\u003e6.Park, J. S., \u0026amp; Ahn, Y. H. Glossopharyngeal neuralgia. \u003cem\u003eJournal of Korean Neurosurgical Society\u003c/em\u003e, 2022;\u003cem\u003e66\u003c/em\u003e: 12\u0026ndash;23. https://doi.org/10.3340/jkns.2022.0178\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Hospital Universitario Mayor Mederi - Universidad del Rosario","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Secondary headache, cancer, neuralgia, glossodynia, Indomethacin test","lastPublishedDoi":"10.21203/rs.3.rs-3898627/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3898627/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Most tongue tumor lesions are evident upon physical examination; however, in cases where this does not happen in such a way, it is possible that invasion to adjacent neural structures may occur, resulting in headache as an initial manifestation.\u003c/p\u003e\n\u003cp\u003eCase presentation: We present the case of a 57-year-old man with continuous hemicranial pain, in whom further studies revealed occult tongue carcinoma as the cause of the headache. After treatment and two-year observation, the patient has remained asymptomatic.\u003c/p\u003e\n\u003cp\u003eConclusions: This report suggests considering the tongue as a potential source of secondary etiologies of persistent hemicranial headache and describes a clinical variant of known cause of glossopharyngeal neuropathy (13.2.2.1 in ICHD III).\u003c/p\u003e","manuscriptTitle":"Occult tongue carcinoma and glossopharyngeal neuropathy: A rare cause of continuous hemicranial pain. A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-29 21:36:08","doi":"10.21203/rs.3.rs-3898627/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"57216d63-cfd8-4073-a097-67adb5eb8024","owner":[],"postedDate":"January 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":28402247,"name":"Neurology"}],"tags":[],"updatedAt":"2024-01-29T21:36:08+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-29 21:36:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3898627","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3898627","identity":"rs-3898627","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}