Paroxysmal head pain with backward radiation: will epicrania fugax go in the opposite direction?

The Journal of Headache and Pain Volume 11, Number 1 / February, 2010 1129-2369 (Print) 1129-2377 (Online)
María Luz Cuadrado1 , Lidia Gómez-Vicente1, Jesús Porta-Etessam1, María Azahara Marcos-de-Vega1, Beatriz Parejo-Carbonell1 and Jorge Matías-Guiu1

(1) Department of Neurology, Hospital Clínico San Carlos and Universidad Complutense, Profesor Martín Lagos s/n, 28040 Madrid, Spain
Received: 25 October 2009 Accepted: 9 November 2009 Published online: 21 November 2009

Abstract Epicrania fugax (EF) has been recently described as a paroxysmal head pain starting in a focal cranial area of the posterior scalp and rapidly spreading forward to the ipsilateral eye or nose along a linear or zigzag trajectory. Here we report two patients presenting with the same clinical features, except for the starting site and the direction of the pain. Unilateral pain paroxysms occurred on either side of the head, with a quick backward radiation along a linear trajectory. The pain always stemmed from a particular point located at the fronto-parietal region, and reached the parieto-occipital region in several seconds. The symptoms did not fit any of the acknowledged headaches and neuralgias, and might correspond to a reverse variant of EF.