Glossopharyngeal neuralgia (GPN) is a rare craniofacial pain syndrome characterized by paroxysmal, severe, unilateral pain in areas innervated by the glossopharyngeal nerve (cranial nerve IX). The pain is typically described as sharp, stabbing, or electric shock-like, with brief episodes that may be triggered by swallowing, speaking, coughing, or yawning. While significantly less common than trigeminal neuralgia, GPN can be equally debilitating. An exceptionally uncommon and potentially life-threatening subtype is the syncopal or vagal variant, in which pain episodes are associated with autonomic symptoms such as bradycardia, hypotension, or syncope, due to involvement of the adjacent vagus nerve (cranial nerve X). We report the case of a 78-year-old woman with a five-year history of paroxysmal Right sided pharyngeal pain radiating to the ear, triggered by actions such as swallowing and speaking. She also experienced dizziness and bradycardia during some attacks. A 24-hour Holter monitor confirmed episodes of bradycardia temporally associated with the pain paroxysms, consistent with the vagal subtype of GPN. Pain remitted spontaneously for up to 12 months but recurred over the past 6 months. Pharmacologic treatment with carbamazepine provided only partial relief. High-resolution brain magnetic resonance imaging (MRI) with angiographic sequences revealed bilateral neurovascular contact involving the glossopharyngeal-vagal complex, particularly on the right, suggesting neurovascular compression as the underlying etiology. This case underscores the importance of recognizing glossopharyngeal neuralgia, especially its vagal variant, as a potentially dangerous but treatable condition. Accurate diagnosis and timely intervention, including neuroimaging and tailored therapy, are essential to prevent complications and improve patient outcomes.