Tongue Pain: Neurological Insights and Causes

Q: Tongue Pain: Neurological Insights and Causes

Hello, Sir： You mentioned that "the symptoms usually occur after taking a shower in the evening (with the neck bent while washing hair)," which may suggest that cervical instability is causing compression of the vagus nerve and hypoglossal nerve, leading to oral burning syndrome.

Tongue issues?

Three years ago, I started experiencing pain in my tongue and mouth, usually on the right side near the base of the tongue and the foliate papillae.
I have visited a teaching hospital for an examination, where both the attending physician and the chief physician evaluated me.
The chief physician could not determine the cause, while the attending physician only noted that it appeared red but normal without any lesions.
Subsequently, I visited a nearby ENT specialist multiple times; the doctor performed palpation twice and visual examinations at least six times, but the conclusions remained the same.
My symptoms fluctuate, and I eventually gave up seeking further medical attention.

Currently, I experience pain when eating, and the location of the pain sometimes shifts to other areas of the mouth or even the ear canal.
Typically, the symptoms flare up after showering at night (with my neck bent while washing my hair).
Sometimes, instead of pain, I feel a sensation of heat, which gradually dissipates by the next morning.
Taking B vitamins or coffee seems to alleviate the symptoms, and moving my right shoulder has a similar effect.
There are times when I go a month without any issues, only to have a flare-up the following month, or I may be fine one week and have symptoms the next.

In the past, I had an injury to my cervical spine at the C5 level, which has left me with significantly reduced grip strength.
This injury was severe enough to warrant a medical exemption from military service.
An initial examination also indicated mild damage to my thoracic spine, and there is clear evidence of injury to the brachial plexus in my left arm.

Could these old injuries potentially be causing discomfort in my tongue or mouth?

Niming, 30~39 year old female. Ask Date: 2022/03/16

Dr. Jiang Junyi reply Neurology

Hello, Sir: You mentioned that "the symptoms usually occur after taking a shower in the evening (with the neck bent while washing hair)," which may suggest that cervical instability is causing compression of the vagus nerve and hypoglossal nerve, leading to oral burning syndrome.
I recommend that you consult a rehabilitation physician for cervical muscle rehabilitation.
Additionally, you can supplement with B vitamins and minimize looking down to avoid cervical instability.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Medical Center, cares about you.

Reply Date: 2022/03/16

More Info

Understanding tongue pain, particularly when it is localized near the base of the tongue and associated with other symptoms, can be complex and multifaceted. Given your history of tongue pain that has persisted for three years, along with previous neck injuries and neurological symptoms, it is essential to consider several potential causes and their implications.

Potential Causes of Tongue Pain
1. Neurological Issues: Given your history of cervical spine injuries, it is plausible that nerve compression or irritation could be contributing to your symptoms. The cervical spine houses nerves that innervate various regions of the head and neck, including the tongue. Conditions such as cervical radiculopathy could lead to referred pain in the tongue or oral cavity. Additionally, the trigeminal nerve, which is responsible for sensation in the face and motor functions such as biting and chewing, could be involved if there is any irritation or damage.

2. Muscle Tension and Myofascial Pain: Your description of symptoms worsening after certain neck positions (like bending while washing your hair) suggests that muscle tension or myofascial pain could be a factor. The muscles of the neck and jaw can become tense and lead to referred pain in the tongue and oral cavity. This is often seen in individuals with chronic neck pain or postural issues.

3. Oral and Dental Issues: While you have had multiple examinations with no clear findings, it is still important to rule out any underlying dental issues, such as temporomandibular joint (TMJ) disorders, which can cause pain that radiates to the tongue and ear. Additionally, conditions like glossitis (inflammation of the tongue) or oral thrush could cause localized pain, although you mentioned that there were no visible lesions.

4. Nutritional Deficiencies: You noted that taking B vitamins or caffeine seems to alleviate your symptoms. Deficiencies in certain vitamins, particularly B12, can lead to glossitis and oral pain. It might be worthwhile to have your vitamin levels checked, especially if your diet has been inconsistent.

5. Psychological Factors: Chronic pain can often be exacerbated by stress or anxiety. If you find that your symptoms fluctuate with your emotional state, it might be beneficial to explore this aspect with a healthcare professional.

Recommendations for Management
1. Neurological Evaluation: Given your history of cervical spine injury and ongoing symptoms, a thorough evaluation by a neurologist is recommended. They may suggest imaging studies (like an MRI of the cervical spine) to assess for any nerve compression or other abnormalities.

2. Physical Therapy: Engaging in physical therapy focused on the neck and jaw may help alleviate muscle tension and improve posture, potentially reducing your symptoms. Techniques such as myofascial release or trigger point therapy could be beneficial.

3. Pain Management: If your symptoms are severe, discussing pain management options with your healthcare provider may be appropriate. This could include medications, nerve blocks, or other interventions.

4. Nutritional Assessment: A consultation with a nutritionist could help ensure that you are meeting your dietary needs, particularly regarding B vitamins and other essential nutrients.

5. Stress Management: Incorporating stress-reduction techniques such as mindfulness, yoga, or cognitive-behavioral therapy may help manage the psychological aspects of chronic pain.

Conclusion
In summary, your tongue pain could be multifactorial, involving neurological, muscular, nutritional, and psychological components. A comprehensive approach that includes further evaluation, physical therapy, nutritional assessment, and stress management may provide relief and improve your quality of life. It is crucial to continue seeking medical advice until you find a satisfactory explanation and treatment for your symptoms.

Similar Q&A

Understanding Lingual Pain: Causes and Solutions for Tongue Discomfort

My mother has been experiencing swelling and pain in her tongue for the past six months. Visually, there are no abnormalities on the tongue. The pain extends from the sides of the tongue to the tip, and it worsens particularly in the afternoon and evening, affecting her sleep. Sh...

Dr. Lin Qingye reply Dentistry
Hello, Xiao Feng: There are many tissues in the oral cavity, and their conditions can sometimes be related. We would like to know about your mother's daily routine, any other medical history, and whether she is currently taking any medications, as these factors can influence...

Understanding Lingual Discomfort: Causes and Solutions for Your Symptoms

In the past two days, I have been experiencing a sour and tingling sensation on my tongue that persists continuously, with occasional breaks. It feels quite uncomfortable. I have had similar experiences before. Please tell me why this is happening and how I can improve it.

Dr. Wu Jinjun reply Dentistry
The phenomenon of abnormal sensations in the tongue can have many causes, including pernicious anemia, diabetes, hyperacidity, trigeminal nerve disorders, psychological issues, salivary gland dysfunction, hypothyroidism, medication (such as antibiotics), irritation from dentures,...

Unraveling Mysterious Tongue Pain: A Neurological Perspective

Three years ago, after drinking a bottle of Pom juice one night, I started experiencing pain in my tongue. At that time, several areas were red but without any sores, and the pain persisted. I went to a teaching hospital for an examination, where both the attending physician and ...

Dr. Jiang Junyi reply Neurology
Hello, Sir: The issues you mentioned may be related to rheumatologic and immunologic disorders. It might be worth considering Behçet's Disease, which has the following major diagnostic criteria: recurrent oral ulcers, skin lesions such as erythema nodosum, subcutaneous venou...

Understanding Tongue Rigidity: Symptoms and Possible Causes

Hello Doctor: About six months ago, I started to feel a lack of dexterity in my tongue. Initially, it was just a sensation of stiffness that did not affect my speech, and the condition fluctuated. In recent months, whenever I speak a bit faster, I often feel like my tongue is get...

Dr. Chen Shunsheng reply Rare Disease
Diseases affecting tongue movement include lesions of the muscles, peripheral nerves (cranial nerves), brainstem motor nuclei, and upper motor neuron lesions. It is important to see a neurologist as soon as possible to determine the location of the lesion and identify the underly...