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.
Showing posts with label epicrania fugax. Show all posts
Showing posts with label epicrania fugax. Show all posts
Wednesday, January 27, 2010
Epicrania Fugax: Ten New Cases and Therapeutic Results
Headache 2010;••:••-••
Angel L. Guerrero, MD; María L. Cuadrado, MD, PhD; Jesús Porta-Etessam, MD; Rocío García-Ramos, MD, PhD; Lidia Gómez-Vicente, MD; Sonia Herrero, MD; María L. Peñas, MD; Rosa Fernández, MD, PhD
From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, S. Herrero, M.L. Peñas, and R. Fernández); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, J. Porta-Etessam, R. García-Ramos, and L. Gómez-Vicente).
Correspondence to A.L. Guerrero, Neurology Department, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain.
Conflict of Interest: None
Copyright © 2010 American Headache Society
ABSTRACT
Objective.—We aimed to report 10 new cases of epicrania fugax (EF), showing their clinical features and therapeutic responses.
Background.—Epicrania fugax has been recently described as a paroxysmal head pain starting in a focal area located at a posterior cranial region and rapidly spreading forward to the ipsilateral eye or nose along a linear or zigzag trajectory. In some patients the pain is followed by ocular or nasal autonomic features. In the prior series, 1 patient got pain relief with anesthetic blockades, while another patient improved with carbamazepine.
Methods.—Since the first description of EF, we have assessed 10 patients with the same clinical picture (8 women and 2 men) at the Neurology outpatient offices of our 2 centers.
Results.—The mean age at onset was 48.5 years (SD: 19.8, range: 23-83). All the patients complained of strictly unilateral pain paroxysms starting at parietal (n = 5), occipital (n = 4), or parieto-occipital locations (n = 1), and immediately spreading forward through a linear pathway toward the ipsilateral forehead (n = 3) or the ipsilateral eye (n = 7), the complete sequence lasting 1-10 seconds. No trigger was identified in any of our patients, while 5 of them suffered mild pain in the stemming area between the paroxysms. Three patients had ipsilateral lacrimation, and 2 had conjunctival injection at the end of the attacks. The frequency ranged from 1 attack per week to multiple attacks per day. Neuroimaging and laboratory tests were consistently normal. Interictal pain was responsive to acetaminophen. In 3 cases a preventive was considered in order to avoid the paroxysms. Gabapentin led to significant improvement in 2 cases. The third patient did not obtain any benefit from gabapentin or amitriptyline, but improved slightly with lamotrigine.
Conclusions.—This description reinforces the proposal of EF as a new headache variant or a new headache syndrome. Anesthetic blockades, carbamazepine, gabapentin, and lamotrigine have been apparently effective in individual patients. Further observations and therapeutic trials are needed.
Accepted for publication November 24, 2009.
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1526-4610.2009.01607.x About DOI
Angel L. Guerrero, MD; María L. Cuadrado, MD, PhD; Jesús Porta-Etessam, MD; Rocío García-Ramos, MD, PhD; Lidia Gómez-Vicente, MD; Sonia Herrero, MD; María L. Peñas, MD; Rosa Fernández, MD, PhD
From the Neurology Department, Hospital Clínico Universitario, Valladolid, Spain (A.L. Guerrero, S. Herrero, M.L. Peñas, and R. Fernández); Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (M.L. Cuadrado, J. Porta-Etessam, R. García-Ramos, and L. Gómez-Vicente).
Correspondence to A.L. Guerrero, Neurology Department, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain.
Conflict of Interest: None
Copyright © 2010 American Headache Society
ABSTRACT
Objective.—We aimed to report 10 new cases of epicrania fugax (EF), showing their clinical features and therapeutic responses.
Background.—Epicrania fugax has been recently described as a paroxysmal head pain starting in a focal area located at a posterior cranial region and rapidly spreading forward to the ipsilateral eye or nose along a linear or zigzag trajectory. In some patients the pain is followed by ocular or nasal autonomic features. In the prior series, 1 patient got pain relief with anesthetic blockades, while another patient improved with carbamazepine.
Methods.—Since the first description of EF, we have assessed 10 patients with the same clinical picture (8 women and 2 men) at the Neurology outpatient offices of our 2 centers.
Results.—The mean age at onset was 48.5 years (SD: 19.8, range: 23-83). All the patients complained of strictly unilateral pain paroxysms starting at parietal (n = 5), occipital (n = 4), or parieto-occipital locations (n = 1), and immediately spreading forward through a linear pathway toward the ipsilateral forehead (n = 3) or the ipsilateral eye (n = 7), the complete sequence lasting 1-10 seconds. No trigger was identified in any of our patients, while 5 of them suffered mild pain in the stemming area between the paroxysms. Three patients had ipsilateral lacrimation, and 2 had conjunctival injection at the end of the attacks. The frequency ranged from 1 attack per week to multiple attacks per day. Neuroimaging and laboratory tests were consistently normal. Interictal pain was responsive to acetaminophen. In 3 cases a preventive was considered in order to avoid the paroxysms. Gabapentin led to significant improvement in 2 cases. The third patient did not obtain any benefit from gabapentin or amitriptyline, but improved slightly with lamotrigine.
Conclusions.—This description reinforces the proposal of EF as a new headache variant or a new headache syndrome. Anesthetic blockades, carbamazepine, gabapentin, and lamotrigine have been apparently effective in individual patients. Further observations and therapeutic trials are needed.
Accepted for publication November 24, 2009.
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1526-4610.2009.01607.x About DOI
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