This is an unusually personal article, an exploration of a medical problem that relates to pain indirectly. I’ve only occasionally used the PainScience.com platform in this way (other examples include the story of my knee injury, ripping up my shoulder, and my truly epic insomnia). But globus can hurt, it’s very musculoskeletal in character, often associated with neck pain, involves some truly neat biology and science, and I really do think this article will help some people. There are precious few detailed articles about this condition out there (like, er, none), and certainly none like this.
It was just the right sort of day for a stress-triggered medical problem: moving day. The lump in my throat was like a thick booger I couldn’t swallow. Or a medium-sized pill lodged in my esophagus. Or a finger pressing firmly on my trachea. As moving day wore on, it grew under my Adam’s apple until I noticed I was clearing my throat as often as I swallowed. I kept trying to spit it up, and getting nothing.
It was fucking frustrating. Painless,1 but deeply unsettling.
This sensation, in the absence of any physical obstruction in the throat, is called globus pharyngis, or — if you’re in a more judgemental mood — the old-timey term globus hystericus, which bluntly suggests a psychosomatic cause. Globus feels like something in your throat, but it’s all in your head. Apparently.
My initial battle with globus felt like the longest couple weeks of my life, peaking with some terrifying swallowing awkwardness for a few days in the middle. I then continued to suffer off and on for ten months. For a sensory phantom, globus is quite the bully.
My globus was definitely a complication of another problem. It was just one part of a larger medical drama that had started months before, in the summer of 2014. I’d had months of odd throat symptoms leading up to the globus, and those throat symptoms lasted until the middle of summer 2015… when I finally found and removed the cause of my throat pain, after 10 months of serious misery. My globus then resolved over a few weeks after that. It was hell, but it definitely ended.
You can skip to the unusual good-news ending… or read about the story as I experienced it.
My globus story is here to help you, the globus sufferer searching the Internet. If this article reassures you, or anything else, please drop me a line and tell me about it. It’s is also just pure emotional venting for me. I need to write about this. I feel like I’ve been through hell, and I just need to talk about it.
By late on moving day — a Saturday — I was starting to really worry. It felt so much like there was something in my throat that I kept shining a flashlight down my gullet. I saw a harmless and irrelevant nodule on my uvula,2 but that’s what I fixated on at first, When you have a lump in your throat that won’t go away, most people think cancer. I sure as shit did. even though it was much higher in the throat than my globus sensation. This is the problem with trying to diagnose yourself, kids.
Remember, I’d been having months of other odd throat symptoms. So it didn’t take much to get my imagination revved up. Basically, when you have a lump in your throat that won’t go away, most people think cancer. A Wikipedia page on cricopharyngeal spasm (more on this below) says:
These spasms are frequently misunderstood by the patient to be cancer.
I sure as shit did.
I woke up Sunday morning to find the lump gone. Bliss! I felt like cheering. I kept swallowing experimentally and grinning madly. Callooh, callay, it’s gone! Phew! This was also my first helpful hint that it probably wasn’t cancer. As a general rule, tumours don’t
Alas, I was also about to be hammered by the discovery that globus typically worsens as the day goes on. By midday, it started to niggle, and within a couple more hours I had to concede that The Lump was back. I found it emotionally impossible to keep in mind that it wasn’t acting much like a tumour. I spent the rest of the day in a state of extreme anxiety and frustration. A couple times, I was squirming on the edge of panic, fighting the impulse to whimper and scream, like I was waking up from a nightmare about swallowing something too large.3
Oddly, my symptoms backed off almost completely later in the evening. As I relaxed. Another clue!
On the third day, I got woozy: I had head rushes every other time I stood up all day long, which greatly exacerbated my fear of seriousness illness. Of course, I was also exhausted and strung out.4 But in my mind, it was all “okay, I guess I’m probably dying now or something.”
And then there was the T-shirt. We all know how dangerous they can be.
As the globus set in for the afternoon, it had a more dire quality to it than before. It had merely been irritating and worrisome. When I put on a fresh T-shirt with a fairly high and tight collar, I felt like I was being strangled. When I put on a fresh T-shirt with a fairly high and tight collar, I felt like I was being strangled. I lightly touched my trachea and discovered that even a tiny amount of pressure felt extremely threatening.
That’s it! I thought. To the walk-in clinic! It was dark and raining like movie rain, but I trudged out and walked ten minutes to the clinic in my new neighbourhood… and found they had a minimum one-hour wait.
I wasn’t that scared. I’m a busy man! I went back home. Maybe in the morning.
As the days marched on, I suffered quite a bit, and learned three main things:
“You encouraged me to come back early if I needed to,” I said to the ENT specialist, a big, genial guy with a thick silver chain around his neck. “So I’m back early because I have a new symptom that’s freaking me out. I’ve never wanted anyone to stick a scope down my throat so badly. Please look in there and tell me what you see.”
Avoid throat scopes if you can. Laryngoscopy feels like being force fed a whole chopstick. It’s one the crappiest experiences I’ve ever had in a doctor’s office. He’d done it once before after spraying the back of my throat with a topical aneasthetic. This time he did it without the numbing, for no apparent reason: just snuck up on me, the bastard. If he ever tries that again, he’s going to end up with a me-shaped hole in his door from my cartoonish exit.
So after a week of having an incredibly distinct sensation of something lodged in my throat, what did he find?
Nothing. Nothing at all. Just a nice smooth pink tube.
I could go on for paragraphs about the doctor and what we discussed, but blah blah blah. He found nothing, he diagnosed globus. He tried to reassure me that there probably is something “real” going on, but the lump sensation itself … globus. His prescription:
“Calm. The fuck. Down.”
Okay, he didn’t actually swear, but you could tell he wanted to. I more or less accepted his diagnosis.
On the 8th day, I read Wikipedia. Beware of Googling your medical problems. Seriously. Watch this pretty hilarious video about how perilous it is. But I’m an expert — I sort of do this kind of reading for a living — so I dared.
Within minutes I discovered a perfect description of my globus, and I do mean perfect.
Specifically, a sub-type of globus — cricopharyngeal spasm — fit me better than my skin. What a strange sensation, to find one’s misery captured precisely in a bulleted list.Some of it was eerily accurate, like “The symptoms can be mimicked by pushing on the cartilage in the neck, just below the Adam’s apple” and “eating, in fact, often makes the tightness go away for a time.” Yeah. That’s me, to a T.
What a strange sensation, to find one’s misery captured precisely in a bulleted list. Strange…but good, because according to Wikipedia, cricopharyngeal spasm is a
harmless, if uncomfortable, self-limiting disorder and will resolve itself over a period of time.
I felt better for the first time in a week. I really did.
On the Monday of the second week, I made myself my favourite breakfast: a nice little omelette, hot and soft. The trick is not to overdo them, mere seconds in the pan, like Julia Child taught me. I had no globus as I prepared them. I wasn’t expecting any trouble.
And then I choked on my eggs.
Swallowing felt distinctly awkward, and I couldn’t get a bite down. I had to cough a bit of it back up.
Betrayed by an omelette! It was emotionally shattering. The most comforting thing I’d learned the day before — “eating often helps” — was destroyed in a few moments. Cancer fear rushed back in like a dark tide. Difficulty swallowing felt like confirmation of my worst fears. If I was struggling to swallow, there had to be something obstructing my throat? Amiright?6
Confession: I’ve never been good at swallowing.
When I was about five, I heard a story about my great grandmother getting a fishbone stuck in her throat… and that story stuck in my mind, forever. I hate taking pills, always have. I couldn’t really handle eating fish until I was in my twenties, and I’m still annoyingly cautious with them to this day. I have been known to give up on mouthfuls of perfectly good steak and spit them out, because I just couldn’t get the bolus positioned for a swallow that felt safe. I went through a period about three years ago where I actually felt nervous of swallowing almost anything even slightly difficult, for no apparent reason. I got over it just as it was really getting to be Quite A Thing.
Yeah, I’m a freak. Just something “funny” about me!
All this is was like sensory gasoline on the bonfire of my globus. I had a bad moment with swallowing my soft eggs, and it triggered an emotional chain reaction. Everyone has bad moments swallowing, but my moment turned into a 3-day nightmare because of my swallowing idiosyncrazy.
I guess. I’ll never really know. But it’s a good working theory.
Job one on day nine — yeah, we’re still on day nine here — was to get the cancer fear under control. An ENT specialist had looked down my throat 36 hours earlier and seen nothing. It seemed implausible to me that any kind of throat cancer could possibly be missed in a careful throat exam on Saturday, yet cause swallowing trouble on Monday. But I couldn’t confirm this in an hour of furious Googling. I needed to talk to a doctor.
I signed up for an extremely new-fangled online medical consultation service. A doctor friend of mine had invested in the company a year before and encouraged me to give it a try. So I finally did, and soon enough I was video chatting with an amiable 70-year-old physician who appeared to be hanging out at home. He was quite helpful.
“A medical student couldn’t have missed that,” he said. “The most incompetent non-specialist would have seen something.”
Upper throat cancers (squamous-cell carcinomas) are quite visible to a scope by nature — they mostly grow on the exposed surfaces of the esophagus and trachea — where cells have been abused by smoke or booze for decades, especially the combination. Fit, younger non-smokers and moderate drinkers are nearly immune.7
“Nothing’s impossible, but your risk of a cancer here is absurdly low.”
Thanks, virtual doctor.
“But let me prescribe something a little unconventional for your lump,” he said. And then he prescribed homeopathy. Groan.8 But I already had what I needed. That was more or less the last of the cancer fear.
On the flipping of omelettes, Julia Child said something like, “You just have to go for it. You must have the courage of your convictions!”9 So it is with swallowing. “You just have to go for it. You must have the courage of your convictions!” Swallowing is not a thing you can think your way through. You must let the reflexes do their work. You have to just go for it.
Easier said than done, when you’re flustered.10
I didn’t have any more difficulty actually getting food down. Nothing got “stuck” again — maybe a little bit once or twice, like a pill going down slowly, something I’ve felt hundreds of times in my life. Acknowledging this now makes it seem like it was all much ado about nothing, but it was scary as hell to live through.
The low point was on day 12, when I was just so strung out and tired that I couldn’t get through a bowl of soup — even though I was quite hungry. But the next night, starving and pissed off, I ate about five pounds of sushi without a hitch.
After I got over the Great Swallowing Terror o’ 2014, the lump as I had known it died down steadily and hasn’t returned in several days.
I doubt it’s the end of my throat story, and it may not even be the end of my globus — apparently it can be intermittent and variable in character for months at a time [already confirmed by the time of publishing this] — but it probably was the end of feeling bullied by it [also confirmed].
Now, about the whole “all in your head business.” I’ve left the most interesting part of the puzzle for last…
Globus is considered to be likely psychosomatic in the absence of actual lumps. For example, although “the differential diagnosis is vast” (translation: there are many possibilities!) Finkenbine and Miele (2004) define globus in the absence of a mass as “a form of conversion disorder.”
Conversion disorder is psychiatrist-speak for a condition (Mayo Clinic) “in which you show psychological stress in physical ways. The condition was so named to describe a health problem that starts as a mental or emotional crisis — a scary or stressful incident of some kind — and converts to a physical problem.” Specifically, a physically disability — an inability to do something, like walking, seeing, or swallowing.
And so — assuming there really is no literal lump — globus is a conversion disorder. Which is a sub-type of somatoform disorder, a larger category of physical disorders caused by mental illness. Which is a good-news, bad-news kind of thing.
The worst diseases known to science pale in comparison to the chronic and untreatable nature of somatoform disorders.
Mark Reid, MD, Twitter, @MedicalAxioms, Apr 16, 2015
Sometimes the globus sensation is caused by a real lump of some kind — just one that’s not obvious at first. The medical literature is chock-a-block with examples of globus with sneaky physical causes that dodge diagnosis at first.
One chilling paper describes a bone tumour growing on the front of the spine, projecting forward into the throat (Wong 2013). A relatively smooth mass, covered by layers of tissue, such a tumour could grow for a long time in secret, slowly but surely pinching the throat shut.
Yeah, creepy as hell. And I thought a fishbone was bad.
But such a tumour would also be distinctively unrelenting. Bone tumours just don’t back off when you pop a Lorazepam, like my globus does.11 A signature feature of a psychosomatic globus sensation is its sensitivity to emotional state, potentially as unpredictable as the weather. I can imagine some minor symptomatic ups and downs on the road to diagnosing such a cancer, the downward trend would be hard to miss — steadily changing from annoying to downright unpleasant.
A weirder example is Eagle Syndrome: a seemingly mechanical source of throat trouble that can act pretty strangely, like globus itself.
Eagle Syndrome is an irritation around the tip of an odd little bone at the back of the throat, the styloid bone, which looks like the fang of a sabre-toothed squirrel. The styloid can get too long and start to bother the sensitive anatomy around the tip, nerves and arteries.
Except fairly often people get Eagle Syndrome symptoms — including globus — without having an abnormally long styloid at all. So that’s odd.
Nor does a long styloid necessarily cause any grief! Not even close, in fact.12 As with most musculoskeletal conditions, there seem to be X-factors that make the hazards of long styloid bones less straightforward than they seem. No one knows what those factors are, of course.
In the whole globus saga so far, gargling has demonstrated to me best of all that I don’t have a mass in my throat, that the globus sensation is an ephemeral phenomenon — a spasm that can melt away like ice cream on a hot day, in the right circumstances.
Initially, I could only slowly and uncertainly relax my way out of it. I took all evening: a hot bath, a lie down, some deep breathing, sex, an hour of watching The Walking Dead (so peaceful!).
But then I discovered that garling could usually put a stop to it almost immediately. Gargling seems to relax the throat by stretching and vibrating it at the same time. A warm gargle may be even more soothing. It is a very unusual sensory experience. After gargling for 1-2 minutes — that’s quite a lot, try it sometime — I can get nearly complete relief from the globus sensation for at least a half hour, often much more (hours). Not bad. And quite informative about the nature of the beast.
How does a somatoform disorder cause pain anyway? How do you go from a mental state to a physical pain? There are several possible mechanisms, but one of the most likely is the formation of so-called “trigger points” — mysterious patches of oversensitive soft tissue, particularly muscle. They are a well-described but poorly understood phenomenon, and crop up in all kinds of other chronic pain problems. Muscle is everywhere, so it can be the delivery system for an incredible array of miseries.
Like painful globus pharyngis, I imagine — though I have no evidence of it, only my personal experience and expertise. I’ve written a large and heavily referenced book about trigger points, so I’m familiar with the science.
Globus pharyngis mostly just feels odd and “uncomfortable,” but it can also be outright painful. I’ve experienced plenty of that. What began for me as “just” a weird lump sensation eventually progressed to a constant parade of deep aches and pains throughout the area — like a headache in my throat. On numerous occasions I was able to get temporary relief from these pains simply by gently massaging my neck and throat muscles (eg13)
It’s even possible that trigger points are involved in non-painful globus. Trigger points exist in a “latent” state where they are sensitive only if provoked. They don’t cause pain in this state, but they might cause subtle muscular malfunction and sensory weirdness — which we are probably quite sensitive too in the throat. The same trouble in the back might barely register with us, or only as a “stiff back,” but even the slightest interference with the sensation of swallowing may be much more of a problem.
No, not really: it’s virtually impossible to rule out a physical lump with high confidence at first. There are too many ways that a physical problem could defy confirmation. As time goes on without any true lump being found, your confidence could go up fairly high… but it can’t reach 100%. Probably not even 90%.
Nor can globus as a conversion disorder be confirmed in most cases — not even if you are lucky enough to experience a rapid and complete recovery.
The only way to be nearly certain that it’s not a conversion disorder is to confirm a mass. And nobody wants that. That’s mostly only possible with worst-case-scenario diagnoses.
If you suspect globus, treat it like globus as best you can, and see how it goes.
I’ve had intermittent globus pharyngis symptoms for ten months, mostly mild but often awful. On August 5, something big changed!
I felt a sharp catch in the back of my throat, like I’d swallowed a burr or a scrap of rough sandpaper. I rushed to the bathroom and flushed my tonsil with a syringe full of salty water.
A stone came out. A “tonsil stone,” kind of like a kidney stone. A hard, dark, jagged little rock popped out of my tonsil onto my tongue. I saw it happen. I scooped it out of my mouth with a Q-tip. And I have it in an envelope now.
It is not an imposing size, but neither is a thorn or a thumbtack. You would not want this thing in your eye, your tonsil, or any delicate crevice. It’s removal spelled immedaite relief. Three of my non-globus throat symptoms vanished — symptoms I’d had constantly for a year.
Imagine finally scratching the worst itch of your life.
Imagine the end of Chinese water torture.
Imagine something stuck between your teeth for a year, finally pried loose.
Tonsil stones, it turns out, are a thing. Like kidneys and gall bladders, tonsils can form nasty little calcifications. They are usually just disgusting, not painful, but sometimes they can get unpleasant — like a thorn in the lion’s paw. In this case, it was a thorn I couldn’t see or touch, just a maddening irritation deep in my throat.
What a perfect way to provoke a nice case of globus pharyngeus!
I assume, hope, and pray that the removal of the stone will resolve my globus problem. When I know, I’ll update you…
It seemed like a good bet that the globus would fade away after the stone came out, but there was also the ominous possibility that the stone was only the top of a tonsil iceberg — where there’s one stone, there could be more. Morale was too low for optimism. I did not dare to hope. I just waited.
My globus and pharyngeal freakout did wind down and stop. Hallelujah! But it was not quick.
Recovery was slow enough that I feared it wouldn’t happen at all. For months, I continued to have episodes of globus, lasting from a few hours to several days at a time. Although there was a strong overall pattern of improvement — fewer, shorter, and milder episodes — there were still some very rough patches. At times, I feared that I had successfully gotten ride of the stone, only to be condemned to a lifetime of globus. But the night is always darkest before dawn, and the intensity finally eased, and then disappeared entirely over a few more days.
The last really tough time with globus was about four months Post Stone, and everything since has been fairly mild. And yet I’m still not totally in the clear. Occasionally my pharyngeal muscles feel quite tight, and they tug and twinge and give me the impression that my throat may never be quite the same ever again.
Importantly, even though I got rid of the stone, I am probably still suffering from on-going provocation to my throat: chronically recurring mild infections, which started during the tonsil stone period and yet have continued now for a full year after that. It’s likely that this continuing problem explains why my recovery from globus has been slow and imperfect.
Nevertheless, this case of globus hystericus was clearly not hysterical at all. Far from being “all in my head,” it was provoked by an extraordinary irritant, and it mostly resolved when the irritant was finally removed.
I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.
This is a true reader story about the difference between feeling like there’s something stuck in your throat (globus sensation) and actually having something stuck in your throat. It’s a you’re-not-paranoid-if-they’re-really-after-you story. Bill was definitely in the “actually stuck” category! If I were him, I would have stopped trying to eat poultry…
I had this thing where food, especially of the meat variety, would get stuck halfway down if it wasn’t well chewed. This went on for a long time — about fifteen years — before an emergency surgery finally put a stop to it.
My first notable incident was a Thanksgiving dinner and some turkey was the culprit. I went outside and behind the barn at my parents’ place, where my disgusting noises would not be heard. I don’t remember how long it took to dislodge, but it probably was a good half-hour or more.
I went on to have some seriously ugly episodes with it, sometimes taking a couple hours to clear my throat. I would have to do some pretty gross things to try to get the food down, such as sticking my fingers down my throat. It also would cause some serious pressure and pain and accompanied by ugly sounding heaving. It happened one time on a date. She was very forgiving (and worried).
The final reckoning was caused by some grilled chicken. My very first bite got through virtually un-chewed and immediately got stuck. This one wasn’t going to budge. I was able to get the discomfort to stay relatively tolerable for the evening. It was still there the next day and all the way into the early evening. I would have episodes of severe suffering with the pain and pressure and also occasionally coughing up globs of phlegm. I had to pull over at one point while driving to deal with phlegm coughing/dry heaving/pain episode. It was hell.
I ended up going to the emergency room that evening, twenty-four hours after it got lodged. They put me under and pushed the chunk of chicken down.
They also expanded my esophagus while they were at it. I still have the before and after pics somewhere. Apparently I had a narrow esophagus all of that time. I had an aunt who had the procedure done several times, so I guess it might be inherited. I’ve not gone back to have another expansion. I don’t think it’s narrowed all the way back and I also just make sure to chew meat very well. Only minor episodes since.
If you can get any comfort out of the “other people have bigger problems” trick, that story should do the trick!
Interestingly, Bill never suffered from any fearful swallowing awkwardness, and he never had a phantom lump — just poultry lumps! My experience was a mirror image of Bill: a relatively minor provocation created a huge sensation of throat blockage.
People are different! Bill, for instance, seems quite a lot more stoic and badass than I am. Also more stubborn. Why didn’t you talk to a doctor sooner, Bill, why?!
Seven updates have been logged for this article since publication (2014). All PainScience.com updates are logged to show a long term commitment to quality, accuracy, and currency. more
When’s the last time you read a blog post and found a list of many changes made to that page since publication? Like good footnotes, this sets PainScience.com apart from other health websites and blogs. Although footnotes are more useful, the update logs are important. They are “fine print,” but more meaningful than most of the comments that most Internet pages waste pixels on.
I log any change to articles that might be of interest to a keen reader. Complete update logging of all noteworthy improvements to all articles started in 2016. Prior to that, I only logged major updates for the most popular and controversial articles.
See the What’s New? page for updates to all recent site updates.
— Updated my last update: status report on globus recovery one full year “Post Stone.”
— Added “Appendix: A story about a real lump in the throat.”
— Good news: added another update on my own story, reporting on the successful resolution of my globus.
— Added a section “Maybe muscle pain?” and a good photograph of my bizarre tonsil stone.
— Added an major update: the discovery of a very likely organic cause for my globus.
— Added a brief epilogue, and clarification of several of the all-in-your-head concepts.
— Added information about Eagle syndrome and gargling.