A seven-year-old girl was referred to the child neurology outpatient clinic of Sultan Qaboos University Hospital in Muscat, Oman, in June 2014 by an ear, nose and throat (ENT) specialist from another hospital for an evaluation of pain in her left ear. The pain had started about two and half years previously and was paroxysmal and associated with decreased hearing and tinnitus. The pain typically lasted two to three hours at a time. Initially, the child was only in pain once per month; however, more recently, the frequency had increased to two to three times a day. During episodes of otalgia, the pain was so severe that the girl could do nothing but cry out for help to relieve it. In between these episodes, there were no signs of tinnitus or hearing loss. There were no apparent triggers for the pain, such as swallowing or being touched on the face. The child was referred to a neurosurgeon for consultation and potential decompression. She was also started on gabapentin. This was prescribed initially as a nightly dose of 25 mg which was increased twice weekly to a maximum nightly dose of 100 mg. Conservative management (500 mg of paracetamol) was recommended for relief of the frequency and severity of her ear pain. A follow-up examination indicated an improvement of approximately 50% in the level of pain. triggers pain due to the intermediate nerve, while pain when swallowing is due to the ninth nerve. However, no such triggers were observed for the current patient. An MRI scan revealed that an arterial loop of the AICA was compressing the seventh nerve. Neurosurgical decompression is the definitive treatment for this condition.