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.

Pharmacotherapy of trigeminal neuralgia.

Clin J Pain. 2002 Jan-Feb;18(1):22-7.

Sindrup SH, Jensen TS.

Department of Neurology, Odense and Aarhus University Hospitals, Denmark. s.sindrup@dadlnet.dk

The efficacy of the anticonvulsant drug carbamazepine in the management of trigeminal neuralgia is evidenced in several controlled trials, and the numbers needed to treat to obtain one patient with at least 50% pain relief (NNT) is 1.7. Single small trials have shown that baclofen alone provides pain relief (NNT = 1.4) and that lamotrigine has an additional effect in patients with insufficient relief using carbamazepine or phenytoin (NNT = 2.1). Uncontrolled observations and clinical practice indicate that phenytoin, clonazepam, sodium valproate, gabapentin, and lidocaine will also relieve trigeminal neuralgia. In case of lacking effect of a single drug, combination of two or more drugs may be used, but with the exception of the lamotrigine-carbamazepine combination, this is not evidence-based medicine. Acute exacerbation has successfully been treated with intravenous loading with phenytoin or lidocaine, but again these procedures have not been tested in controlled trials. In conclusion, carbamazepine is the mainstay of pharmacotherapy of trigeminal neuralgia, and secondary drug choices are baclofen, lamotrigine, oxcarbazepine, phenytoin, gabapentin, and sodium valproate. Controlled trials testing the effect of some of these drugs, new drugs, and drug combinations are needed.

Publication Types:
Review

PMID: 11803299 [PubMed - indexed for MEDLINE]