Eagle Syndrome

Eagle Syndrome. It’s rare. It’s sneaky. 

Eagle Syndrome arises from an elongated styloid process or calcified stylohyoid ligament, leading to facial or cervical pain. Symptoms often include jaw tension that mimic temporomandibular joint disorders (TMJ/TMD), glossopharyngeal neuralgia, or cervicogenic headaches. Patient swear there’s something “stuck in their throat.” Eagle Syndrome affects only about 0.16% of the population. While 4% have an elongated styloid process (>3 cm), only a small number develop symptoms. Women are three times more likely to be affected, with most cases diagnosed in the 30s to 40s age range.

During physical examination, palpation of the tonsillar fossa may reproduce symptoms. Pain exacerbation with head rotation or swallowing is common. Differential diagnosis would exclude TMJ disorders, neuralgias, and cervical spine pathologies. (1) 

Imaging and Diagnosis

A 3D CT scan is the gold standard for visualizing styloid elongation or ligament calcification. Panoramic radiographs can also aid in diagnosis, but are less definitive.

Chiropractic Management of Eagle Syndrome

Research on the use of spinal manipulation for Eagle Syndrome is limited. However, some case reports and clinical observations suggest that conservative manual therapies, including chiropractic care, may relieve select patients' symptoms.

Case Reports and Clinical Observations 

• A 2023 case report detailed a chiropractic patient with Eagle Syndrome who experienced significant symptom relief through conservative care. The treatment included gentle cervical mobilization, soft tissue therapy, and postural correction exercises. Imaging confirmed an elongated styloid process, and symptoms improved without surgical intervention. (2) 

• A 2010 case series examined manual therapy assessments in patients diagnosed with Eagle Syndrome. The findings indicated that targeted manual therapy could alleviate symptoms, though the authors emphasized the need for careful assessment and individualized treatment plans. (3)

 Chiropractic Recommendations for Eagle Syndrome

• Before initiating manual therapy, appropriate imaging (e.g., 3D CT scan) must be obtained to assess the styloid process and surrounding structures.

• Gentle, non-thrust chiropractic techniques, focusing on soft tissue mobilization and postural correction.

• Avoiding high-velocity cervical manipulations in patients with Eagle Syndrome or significantly elongated styloid processes.

• Collaborating with ENT specialists or maxillofacial surgeons for comprehensive care, particularly if conservative measures are ineffective.

In Summary 

No reliable research demonstrates that spinal manipulation is indicated for patients with Eagle Syndrome; this does not mean patients cannot benefit from chiropractic care. Chiropractors conduct a thorough assessment to identify Eagle Syndrome and develop an individualized treatment plan prioritizing patient safety. Appropriate care may include posture correction, gentle soft tissue work around the affected areas, and targeted rehabilitation, excluding spinal manipulation. 

If conservative, non-invasive treatments prove ineffective, a referral to an ENT specialist for potential surgical intervention, such as a styloidectomy, would be considered.

REFERENCES

      1. Bokhari MR, Graham C, Mohseni M. Eagle Syndrome. [Updated 2023 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing

      2. Vernon LF. A Case of Eagle Syndrome in a Chiropractic Patient. Cureus. 2023 May 2;15(5):e38426. doi: 10.7759/cureus.38426. 

      3. Johnson GM, Rosdy NM, Horton SJ. Manual therapy assessment findings in patients diagnosed with Eagle's Syndrome: a case series. Man Ther. 2011 Apr;16(2):199-202. doi: 10.1016/j.math.2010.09.007.

      4. Dr. Brandon Steele, Eagle Syndrome: A Chiropractic Perspective. ChiroUp Website and Blog, June 05, 2025