Symptoms of Eagle syndrome

The symptoms of Eagle syndrome depend on which structure the styloid process, or a calcified stylohyoid ligament, presses on: the throat and its nerves, the carotid artery, or the internal jugular vein. Most people with an elongated styloid on both sides have symptoms on only one side1. Symptoms are often brought on or made worse by turning the head, swallowing, yawning, chewing or talking12.

Classic Eagle syndrome

Classic Eagle syndrome causes pain and discomfort in the throat, ear, jaw and neck, usually on one side. The main symptoms are:

• throat pain, often felt deep in the throat near the tonsil or the back of the tongue
• a feeling of something stuck in the throat, sometimes described as a fishbone that never clears
• pain on swallowing (odynophagia) and difficulty swallowing (dysphagia)
• ear pain (otalgia) with no sign of ear disease, because the pain is referred from the throat
• neck pain, and pain spreading to the jaw, face or temple
• pain triggered or worsened by turning the head

In a US series of 21 patients who had surgery, the most common complaints were neck pain (81%), throat pain (62%) and ear pain (48%)3. Difficulty swallowing and neck pain are more typical of the classic form than of the vascular form2.

The pain varies. When the styloid process irritates the glossopharyngeal nerve, which carries sensation from the tonsils and the back of the tongue, the pain can be sharp and shooting, close to that of glossopharyngeal neuralgia. Other patients describe a dull, throbbing ache1.

Classic Eagle syndrome often follows a tonsillectomy. In a 2024 review of published patients, 48 of 153 with the classic form had had their tonsils removed, compared with 2 of 33 with the vascular form2. A foreign-body feeling and pain on swallowing are also the symptoms most likely to disappear completely after surgery4.

Carotid Eagle syndrome

When the styloid process presses on or injures the carotid artery, the symptoms are those of reduced blood flow to the brain or damage to the artery wall:

• mini-strokes (transient ischemic attacks): brief weakness, numbness, loss of vision in one eye or trouble speaking that clears within minutes or hours
• stroke
• headache, and pain in the neck, face or around the eye
• Horner syndrome: a drooping eyelid, a small pupil and less sweating on one side of the face
• fainting or dizziness, sometimes when turning the head

Headache and Horner syndrome are more frequent in the vascular form, and neck movement is a more common trigger: 12 of 33 patients with vascular Eagle syndrome in the 2024 review reported it2. The vascular form also affects men more often, who made up 70% of those patients. Among 231 published patients with vascular complications, stroke was the most frequent result of arterial compression, occurring in 46.8%5. Some of these strokes follow a carotid artery dissection, a tear in the artery wall6.

Stroke symptoms need emergency care. Call your local emergency number straight away, even if the symptoms are passing. Mini-strokes caused by the styloid process tend to come and go, but they can be a warning of a stroke1.

Jugular compression

When the internal jugular vein is squeezed between the styloid process and the first vertebra of the neck (C1), blood drains from the brain less freely and the pressure inside the skull can rise. Typical symptoms are:

• chronic headache, often with a feeling of pressure in the head
• pulsatile tinnitus, a whooshing sound in the ear in time with the heartbeat
• visual disturbance, such as blurred vision
• difficulty concentrating, often called brain fog
• symptoms that change with head position

Chronic headache was the most frequent symptom of venous compression among published patients with vascular complications, reported in 68%5. A review of surgical series lists headache, blurred vision, tinnitus and brain fog as the main symptoms7. In a series of 10 patients, bending the neck forward made the headache worse in 7, and turning the head to the opposite side raised the venous pressure in all 108. A 2026 case report describes the full pattern: years of pulsatile tinnitus, headaches, visual and cognitive disturbance and head pressure, all of which resolved after the vein was decompressed9.

The jugular compression page explains how the vein is narrowed and how this is investigated.

Other symptoms

People with Eagle syndrome also report dizziness, ringing in the ears and tingling in the face12. These symptoms have many other causes and are less specific to the styloid process.

When to see a doctor

See a doctor about throat, ear or neck pain on one side that lasts for weeks, especially pain that started after a tonsillectomy or comes with swallowing or turning the head. Persistent one-sided throat pain also needs examination to rule out other causes, including infection, dental disease and, rarely, cancer of the head and neck1. Hoarseness, a lump in the neck, weight loss or coughing up blood need prompt assessment.

A long styloid process is common, found on about a quarter of sides of the neck in imaging studies10, so symptoms that fit are what make the diagnosis likely. The diagnosis and imaging page explains how clinicians tell Eagle syndrome apart from the conditions it resembles.

References

1. Cleveland Clinic. Eagle syndrome. Reviewed June 25, 2024. Accessed October 3, 2026. Source ↩
2. Hassani M, Grønlund EW, Albrechtsen SS, Kondziella D. Neurological phenotypes and treatment outcomes in Eagle syndrome: systematic review and meta-analysis. PeerJ. 2024;12:e17423. doi:10.7717/peerj.17423 PubMed ↩
3. Hardin FM, Xiao R, Burkey BB. Surgical management of patients with Eagle syndrome. Am J Otolaryngol. 2018;39(5):481-484. doi:10.1016/j.amjoto.2018.05.003 PubMed ↩
4. Bargiel J, Gontarz M, Gąsiorowski K, Marecik T, Wyszyńska-Pawelec G. Outcomes of elongated styloid process syndrome treated with minimally invasive cervical styloidectomy (MICS): a single-center retrospective study. J Clin Med. 2024;13(21):6409. doi:10.3390/jcm13216409 PubMed ↩
5. Thielen A, Brizzi V, Majoufre C, Nicot R, Schlund M. Eagle syndrome and vascular complications: a systematic review. Int J Oral Maxillofac Surg. 2025;54(1):31-42. doi:10.1016/j.ijom.2024.09.011 PubMed ↩
6. Klail T, Sachs L, Panos LD, et al. Styloid process-related internal carotid artery dissection: extensive literature review of diagnosis, treatment and outcomes (exemplified with a single-center case series). Neuroradiology. 2025;67(6):1355-1364. doi:10.1007/s00234-025-03616-y PubMed ↩
7. Petersingham G, Shrestha N, Elliott M, et al. Invasive surgical management of cervical internal jugular venous compression: a literature review. J Clin Neurosci. 2025;137:111304. doi:10.1016/j.jocn.2025.111304 PubMed ↩
8. Zhao X, Cavallo C, Hlubek RJ, et al. Styloidogenic jugular venous compression syndrome: clinical features and case series. Oper Neurosurg. 2019;17(6):554-561. doi:10.1093/ons/opz012 PubMed ↩
9. Aghayev K, Comella Z, Vrionis FD. Internal carotid artery anterior transposition for internal jugular vein decompression: illustrative case. J Neurosurg Case Lessons. 2026;12(9):CASE26599. doi:10.3171/CASE26599 PubMed ↩
10. Triantafyllou G, Paschopoulos I, Duparc F, Tsakotos G, Papadopoulos-Manolarakis P, Piagkou M. The anatomy of the stylohyoid chain: a systematic review with meta-analysis. Diagnostics (Basel). 2025;15(7):925. doi:10.3390/diagnostics15070925 PubMed ↩

Related pages

• Diagnosis and imagingHow Eagle syndrome is diagnosed: examination, CT with 3D reconstruction, CT angiography and venography, jugular pressure tests and reading a report.
• Vascular Eagle syndromeVascular Eagle syndrome: how the styloid process can compress or tear the carotid artery, the link with dissection and stroke, and how it is treated.
• Jugular vein compressionJugular vein compression between the styloid and C1: how it happens, its link with intracranial hypertension, diagnosis, and surgery versus stenting.
• Anatomy of the styloid processThe styloid process and stylohyoid ligament: normal length, types of ossification, the vessels and nerves around them, and the gap between the styloid and C1.