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Friedman DI. Approach to the Patient With Headache. Continuum (Minneap Minn) 2024; 30:296-324. [PMID: 38568485 DOI: 10.1212/con.0000000000001413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE The evaluation of patients with headache relies heavily on the history. This article reviews key questions for diagnosing primary and secondary headache disorders with a rationale for each and phrasing to optimize the information obtained and the patient's experience. LATEST DEVELOPMENTS The availability of online resources for clinicians and patients continues to increase, including sites that use artificial intelligence to generate a diagnosis and report based on patient responses online. Patient-friendly headache apps include calendars that help track treatment response, identify triggers, and provide educational information. ESSENTIAL POINTS A structured approach to taking the history, incorporating online resources and other technologies when needed, facilitates making an accurate diagnosis and often eliminates the need for unnecessary testing. A detailed yet empathetic approach incorporating interpersonal skills enhances relationship building and trust, both of which are integral to successful treatment.
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Garbayo-Salmons P, Expósito-Serrano V, Ribera Pibernat M. Red Ear: A Poorly Understood Syndrome. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113 Suppl 1:S23-S25. [PMID: 36543464 DOI: 10.1016/j.ad.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/15/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- P Garbayo-Salmons
- Servicio de Dermatología, Hospital Universitario Parc Taulí de Sabadell, Sabadell, Barcelona, España.
| | - V Expósito-Serrano
- Servicio de Dermatología, Hospital Universitario Parc Taulí de Sabadell, Sabadell, Barcelona, España
| | - M Ribera Pibernat
- Servicio de Dermatología, Hospital Universitario Parc Taulí de Sabadell, Sabadell, Barcelona, España
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Garbayo-Salmons P, Expósito-Serrano V, Ribera Pibernat M. [Translated article] Red Ear: A Poorly Understood Syndrome. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113 Suppl 1:TS23-TS25. [PMID: 36228708 DOI: 10.1016/j.ad.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/15/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- P Garbayo-Salmons
- Servicio de Dermatología, Hospital Universitario Parc Taulí de Sabadell, Sabadell, Barcelona, Spain.
| | - V Expósito-Serrano
- Servicio de Dermatología, Hospital Universitario Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | - M Ribera Pibernat
- Servicio de Dermatología, Hospital Universitario Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
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Borri J, Silva Junior HMD. Red Ear Syndrome and migraine: case report and review of this peculiar association. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2021.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Introduction: The "Red Ear Syndrome" (RES) is a rare condition (about 100 cases were published in 25 years). It is characterized by episodes of hyperemia of the ear associated with burning pain. Although the association of this syndrome and primary headaches is contemplated in literature, its etiology and treatments are still poorly defined.
The aim of this paper is to report a case of RES related to migraine and possible pathophysiologic mechanisms.
Case Report: A 31-year-old woman presented with stabbing pain and marked erythema and edema of the right ear accompanied by burning and local hyperhidrosis. These attacks lasted 2 hours on average, and either occurred spontaneously or were associated with migraine without aura. The only means of relief during the attacks was cooling the local with ice.
Extensive laboratory-chemical, microbiological, ear-nose-throat, clinical and neurological examinations, magnetic resonance of the brain and cervical spine were unremarkable.
Conclusion: Uncertainty about the etiology of this syndrome is an obstacle to treatment. The frequent relationship between RES and migraine suggests that is necessary to investigate the syndrome in migraineurs. Furthermore, new reports about this disorder are important to increase the knowledge of physicians, to reduce the delay in diagnosis and suffering of patients.
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Duvall JR, Garza I, Kissoon NR, Robertson CE. Great Auricular Neuralgia: Case Series. Headache 2019; 60:247-258. [DOI: 10.1111/head.13690] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jaclyn R. Duvall
- Headache Division Department of Neurology Mayo Clinic Rochester MN USA
| | - Ivan Garza
- Headache Division Department of Neurology Mayo Clinic Rochester MN USA
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Affiliation(s)
- R. Allan Purdy
- Professor of Medicine (Neurology); Dalhousie University; Halifax Canada
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Levandoski KA, Cohen BA, Grossberg AL. Evaluation of a Red Ear in the Pediatric Population. Clin Pediatr (Phila) 2018; 57:629-636. [PMID: 29084450 DOI: 10.1177/0009922817737084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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de Amorim IL, Kauppila LA, Martins IP. Red Ear: Syndrome or Symptom? Headache 2018; 58:885-891. [PMID: 29802637 DOI: 10.1111/head.13333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 01/03/2023]
Abstract
Red ear syndrome (RES) is a rare disorder characterized by attacks of unilateral ear pain during which the ear becomes red. Episodes can occur spontaneously, or be triggered, in most cases, by rubbing or touching the ear. Both duration and frequency are variable. RES has been explained by a dysfunction of cervical spinal nerves (C3 root) and a dysregulation with disinhibition of brainstem trigemino-autonomic circuits, leading to sympathetic inhibition and parasympathetic hyperactivity producing vasodilation. We describe 6 new cases of RES with different characteristics. Although all presented the cardinal symptom of red ear, the headache patterns were suggestive of other primary headaches (migraine or cluster headache). Therapeutic response was obtained when directed to the associated primary headache phenotype, suggesting that RES may be a phenomena associated with different headaches, rather than a syndrome in itself.
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Affiliation(s)
- Isabel Loução de Amorim
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHLN, Lisbon, Portugal
| | - Linda Azevedo Kauppila
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHLN, Lisbon, Portugal
| | - Isabel Pavão Martins
- Department of Neurology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Chan TLH, Becker WJ, Jog M. Indomethacin-Responsive Idiopathic Red Ear Syndrome: Case Report and Pathophysiology. Headache 2017; 58:306-308. [PMID: 29193054 DOI: 10.1111/head.13237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 10/20/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Tommy L H Chan
- Department of Clinical Neurological Sciences, London Health Sciences Centre (LHSC), University of Western Ontario, London, Ontario, Canada
| | - Werner J Becker
- Department of Clinical Neurosciences & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, London Health Sciences Centre (LHSC), University of Western Ontario, London, Ontario, Canada
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Lisotto C, Mainardi F, Maggioni F, Zanchin G. O003. Red ear syndrome: a new form of trigeminal autonomic cephalalgia? J Headache Pain 2015; 16:A127. [PMID: 28132261 PMCID: PMC4715065 DOI: 10.1186/1129-2377-16-s1-a127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Wollina U. Three orphans one should know: red scalp, red ear and red scrotum syndrome. J Eur Acad Dermatol Venereol 2015; 30:e169-e170. [DOI: 10.1111/jdv.13474] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- U. Wollina
- Department of Dermatology; Hospital Dresden-Friedrichstadt; Dresden Germany
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Velasco EM, Mesonero LL, Hueso MIP, Piñero MR, de Lera Alfonso M, Peral ÁLG. Red Ear and More: Facial and Extrafacial Erythema Accompanying Migraine Attacks. Headache 2015; 56:174-5. [PMID: 26474080 DOI: 10.1111/head.12702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 11/29/2022]
Abstract
Cutaneous manifestations of migraine are infrequent and their spectrum is reduced to the red ear syndrome (RES) and eyelid disorders. We report a case of a 26-year-old woman with migraine accompanied by extensive erythema, which involved right ear and cheek and left hemithorax. She fulfilled proposed criteria of RES. We started preventive therapy with a significant response. This is the first description in the literature of an erythema accompanying migraine attacks broadly exceeding the ear.
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Pinto WBVDR, Souza PVSD, Pinheiro JRS, Oliveira ASB. The ear as a diagnostic key in a headache syndrome. ARQUIVOS DE NEURO-PSIQUIATRIA 2015. [PMID: 26222368 DOI: 10.1590/0004-282x20150092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Paulo Victor Sgobbi de Souza
- Divisão de Doenças Neuromusculares, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Jonathan Rafael Siqueira Pinheiro
- Divisão de Doenças Neuromusculares, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Acary Souza Bulle Oliveira
- Divisão de Doenças Neuromusculares, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Moitri MO, Banglawala SM, Archibald J. Red ear syndrome: literature review and a pediatric case report. Int J Pediatr Otorhinolaryngol 2015; 79:281-5. [PMID: 25583087 DOI: 10.1016/j.ijporl.2014.12.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 11/25/2022]
Abstract
Red ear syndrome (RES) is characterized by recurrent unilateral or bilateral painful attacks of the external ear, accompanied by ear redness, burning, or warmth. Proposed etiologies of this rare condition include dysregulation of sympathetic outflow, upper cervical pathology, glossopharyngeal and trigeminal neuralgia, TMJ dysfunction, thalamic syndrome, and primary headache syndromes. Idiopathic cases also exist in the literature. Pediatric cases are particularly rare and more commonly associated with migraine. Given the various potential etiologies, no single treatment is effective in all cases. This paper summarizes the current understanding and management of RES, and describes a case of idiopathic pediatric RES.
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Affiliation(s)
- Misha O Moitri
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5.
| | - Sarfaraz M Banglawala
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5
| | - Jason Archibald
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5
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Flicinski J, Wigowska-Sowinska J, Winczewska-Wiktor A, Steinborn B. Red ear syndrome – Case report and review of literature. Neurol Neurochir Pol 2015; 49:74-7. [DOI: 10.1016/j.pjnns.2015.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 01/05/2015] [Indexed: 11/16/2022]
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Chan CC, Ghosh S. Red ear syndrome precipitated by a dietary trigger: a case report. J Med Case Rep 2014; 8:338. [PMID: 25303997 PMCID: PMC4196464 DOI: 10.1186/1752-1947-8-338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/20/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Red ear syndrome is a rare condition characterized by episodic attacks of erythema of the ear accompanied by burning ear pain. Symptoms are brought on by touch, exertion, heat or cold, stress, neck movements and washing or brushing of hair. Diagnosis and treatment of this condition are challenging. The case we report here involves a woman whose symptoms were brought on by a dietary trigger: orange juice as well as stress, causing significant physical and psychological morbidity. Avoidance of triggers resulted in symptomatic improvement. Case presentation A 22-year-old Caucasian woman who was a student presented twice to our department with evolving symptoms, the first time with hyperacusis (abnormal sound sensitivity arising from within the auditory system to sounds of moderate volume), intermittent right tinnitus and subjective hearing difficulties. She presented five years later with highly distressing episodes of erythematous ears, which were associated with burning pain around the ear and temporal areas, and intolerance to noise. After keeping a symptom diary, she identified orange juice and stress as triggers of her symptoms. No local head and neck pathology was present. Investigations and imaging were negative. Avoidance of triggers led to great symptomatic improvement. To the best of our knowledge, dietary triggers have not previously been reported as a trigger for this syndrome. This case shows a direct temporal link to a dietary trigger and supports a primary pathogenesis. Recognition and management of primary headache disorder and simple dietary and lifestyle changes brought about symptomatic relief. Conclusion Red ear syndrome is a little-known clinical syndrome of unknown etiology and management. To the best of our knowledge, our present case report is the first to describe primary red ear syndrome triggered by orange juice. Clinical benefit derived from avoidance of this trigger, which is already known to precipitate migraines, gives some insight into the pathogenesis of red ear syndrome.
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Affiliation(s)
- Chung Chi Chan
- Department of Audiovestibular Medicine, St Ann's Hospital, St Ann's Road, London N15 3TH, UK.
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Picco PP, D’Alessandro M, Leoni M, Doglio M, Martini A. Primary red ear syndrome associated with cochleo-vestibular symptomatology: A paediatric case report. Cephalalgia 2013; 33:1277-80. [DOI: 10.1177/0333102413493527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Red ear syndrome (RES), first described by Lance in 1996 in an adult series, may be primary or associated with headache syndromes, upper cervical disorders or vascular anomalies. Clinically the disease is characterised by recurrent episodes of reddening and burning pain in the auricle, usually elicited by different triggers. The prevalence of RES in the paediatric age group remains poorly understood. Several therapeutic approaches have been tried with heterogeneous clinical response. Case results We report a paediatric patient suffering from primary RES associated with debilitating cochleo-vestibular symptomatology causing severe discomfort. Three years after the disease onset, the patient also developed headache, with clinical features of migraine. Discussion The temporal and spatial association could suggest shared pathogenetic features between neurological (cochleo-vestibular) and vascular (red and burning ear) symptomatology, likely related to trigeminal autonomic reflex activation, although further studies are required for full comprehension of RES pathogenesis.
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Affiliation(s)
- Paolo P Picco
- Department of Paediatric Rheumatology, G Gaslini Institute, Italy
| | | | | | - Matteo Doglio
- Department of Paediatric Rheumatology, G Gaslini Institute, Italy
| | - Alberto Martini
- Department of Paediatric Rheumatology, G Gaslini Institute, University of Genoa, Italy
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