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Correnti E, Lo Cascio S, Cernigliaro F, Rossi R, D'Agnano D, Grasso G, Pellegrino A, Lauria B, Santangelo A, Santangelo G, Tripi G, Versace A, Sciruicchio V, Raieli V. Idiopathic Non-Dental Facial Pain Syndromes in Italian Children: A Clinical Case Series. Life (Basel) 2023; 13:life13040861. [PMID: 37109390 PMCID: PMC10144764 DOI: 10.3390/life13040861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/08/2023] [Accepted: 03/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes characterized by painful attacks involving the orofacial structures. They may be summarily subdivided into two great categories: (1) orofacial pain mainly attributed to dental disorders such as dentoalveolar and myofascial orofacial pain or temporomandibular joint (TM) pain; (2) orofacial pain mainly attributed to non-dental pain as neuralgias, facial localization of primary headaches or idiopathic orofacial pain. The second group is uncommon, often described by single case reports, can often show overlapping symptoms with the first group, and represents a clinical challenge, carrying the risk of undervaluation and possibly invasive odontoiatric treatment. We aimed to describe a clinical pediatric series of non-dental orofacial pain and better to underline some topographic and clinical features associated with them. We retrospectively collected the data of children admitted to our headache centers (Bari, Palermo, Torino) from 2017 to 2021. Our inclusion criterion was the presence of non-dental orofacial pain following the topographic criteria of 3° International Classification of Headache Disorders (ICHD-3), and exclusion criteria included the pain syndromes attributed to the dental disorders and pain syndromes due to the secondary etiologies Results. Our sample comprised 43 subjects (23/20 M/F, in the range of ages 5-17). We classified them int: 23 primary headaches involving the facial territory during attacks, 2 facial trigeminal autonomic cephalalgias, 1 facial primary stabbing headache, 1 facial linear headache, 6 trochlear migraines, 1 orbital migraine 3 red ear syndrome and 6 atypical facial pain. All patients described debilitating pain for intensity (moderate/severe), 31 children had episodic attacks, and 12 had continuous pain. Almost all received drugs for acute treatment (less than 50% were satisfied), and some received non-pharmacological treatment associated with drug therapy Conclusion. Although rare OFP can occur in pediatric age, it can be debilitating if unrecognized and untreated, affecting the psychophysical well-being of young patients. We highlight the specific characteristics of the disorder for a more correct and earlier identification during the diagnostic process, already difficult in pediatric age, and to define the approach and possible treatment to prevent negative outcomes in adulthood.
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Affiliation(s)
- Edvige Correnti
- Child Neuropsychiatry Department, ISMEP, ARNAS Civico, 90100 Palermo, Italy
| | - Salvatore Lo Cascio
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Federica Cernigliaro
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Roberta Rossi
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Daniela D'Agnano
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Giulia Grasso
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Annamaria Pellegrino
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Barbara Lauria
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Andrea Santangelo
- Pediatrics Department, AOUP Santa Chiara Hospital, 56126 Pisa, Italy
| | | | - Gabriele Tripi
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Antonella Versace
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Vittorio Sciruicchio
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Department, ISMEP, ARNAS Civico, 90100 Palermo, Italy
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Alnosair G, Alqasim R. Pediatric Recurrent Unilateral Trochleitis in Association With Paranasal Sinusitis: A Case Report. Cureus 2022; 14:e31302. [PMID: 36398036 PMCID: PMC9648679 DOI: 10.7759/cureus.31302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/10/2022] Open
Abstract
Trochleitis is an easily treatable condition; however, it is often misdiagnosed by many clinicians because of its rare incidence. We report the case of a 14-year-old Saudi male patient, known to have type 1 diabetes mellitus (DM) and pansinusitis, who presented to the emergency department with a one-day history of severe right periorbital pain exacerbated by upgaze and supraduction. There was intense point tenderness on palpation over the trochlear region of the orbit with no underlying swelling or redness. Both eyes had a corrected visual acuity of 0.8. Mildly limited elevation (-1) of the right eye was noted. All other extraocular movements were normal in both eyes. Contrast-enhanced CT of the head and orbits showed mild trochlear swelling, inflammation, and pansinusitis. He was treated with a single intratrochlear injection of steroids, which immediately and significantly improved the symptoms. To the best of our knowledge, this is the second case of trochleitis associated with paranasal sinusitis in children. This suggests that a possible, but rare, association between these two conditions may exist in the pediatric population.
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Raieli V, Reina F, D’Agnano D, Nocera GM, Capizzi M, Marchese F, Sciruicchio V. The Pediatric Trochlear Migraine: Diagnostic and Therapeutic Implications. J Clin Med 2022; 11:2826. [PMID: 35628950 PMCID: PMC9142906 DOI: 10.3390/jcm11102826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Trochlear Migraine has been recently described as the concurrence of strictly unilateral migraine and ipsilateral trochleodynia with relief of migraine after successful treatment of trochleodynia. This disorder has been interpreted as "cluster-tic syndrome" or "seizure-triggered migraine". Trochlear Migraine is unrecognized and rarely described in childhood. The aim of this study is to review the few cases of Trochlear Migraine reported in the literature in addition to the cases observed in our clinical experience. In particular, our cases showed recurrent attacks of severe and pulsating headache associated with nausea, vomiting, phonophobia, photophobia, and strict trochlear localization of pain. They often presented with alternating side attacks. Therefore, we suggest that the term "Trochlear Migraine" should be reserved for clinical migraine attacks strictly localized in the trochlear region, and we assume that the excessive increase in descriptions of new primary headache syndromes, according to the International Classification of Headache Disorders, can be probably be ascribed to the common physiopathological mechanisms characterizing these forms of migraine.
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Affiliation(s)
- Vincenzo Raieli
- Child Neuropsychiatry Unit ISMEP, ARNAS Civico, 90134 Palermo, Italy;
| | - Federica Reina
- Child Neuropsychiatry School, University of Palermo, 90128 Palermo, Italy; (F.R.); (G.M.N.); (M.C.)
| | - Daniela D’Agnano
- Children Epilepsy and EEG Center, PO, San Paolo ASL, 70132 Bari, Italy; (D.D.); (V.S.)
| | - Giovanna Martina Nocera
- Child Neuropsychiatry School, University of Palermo, 90128 Palermo, Italy; (F.R.); (G.M.N.); (M.C.)
| | - Mariarita Capizzi
- Child Neuropsychiatry School, University of Palermo, 90128 Palermo, Italy; (F.R.); (G.M.N.); (M.C.)
| | | | - Vittorio Sciruicchio
- Children Epilepsy and EEG Center, PO, San Paolo ASL, 70132 Bari, Italy; (D.D.); (V.S.)
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4
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Trochleaectomy: An Effective Treatment of Trochlear Pain in Monocular Patients. J Neuroophthalmol 2021; 41:246-250. [PMID: 32108117 DOI: 10.1097/wno.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Conventional treatment options for trochlear pain arising from trochleitis or primary trochlear headache include oral anti-inflammatory medications and/or local injection of corticosteroids and local anesthetic. Trochleaectomy is an additional option to consider for monocular patients with intractable trochlear pain. METHODS We report 3 patients undergoing trochleaectomy for refractory trochlear pain syndromes. RESULTS Trochleaectomy resulted in resolution of their periocular discomfort. CONCLUSIONS Trochleaectomy is an effective procedure to treat trochlear pain syndrome in functionally monocular patients.
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Rahmani K, Kamali G, Nassiri N. The effect of nonsteroidal anti-inflammatory drugs on eye pain and migraine headache caused by trochleitis. Saudi J Ophthalmol 2021; 35:112-116. [PMID: 35391815 PMCID: PMC8982941 DOI: 10.4103/1319-4534.337861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 12/13/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE: Trochleitis has been recognized as one of the causes of eye pain and migraine headaches. This study attempts to investigate the effect of ibuprofen on reducing eye pain and migraine headaches caused by trochleitis. METHODS: In this before-after clinical trial, out of 1100 clinically examined patients with eye pain and migraine symptoms, 33 patients were diagnosed with having trochleitis and trochleodynia confirmed by orbital magnetic resonance imaging images. Ibuprofen (400 mg/6–8 h) was prescribed to the subjects for 15–30 days. The main outcomes were a reduction in tenderness and pain that were evaluated 2 weeks, a month, and 6 months after the prescription. The data were analyzed by STATA (version 14) and using Wilcoxon and McNemar tests. RESULTS: The results revealed that 28 of the subjects (84.8%) experienced a significant reduction in tenderness 2 weeks after undergoing the treatment (P < 0.001). Standard deviation and average of headache scores before and after the treatment were 7.85 ± 1.75 and 0.64 ± 0.61 based on the visual analog scale. The difference between the pain scores before and after the treatment was statistically significant (P < 0.001). Clinical symptoms such as induration (P < 0.001), photophobia (P < 0.001), upward gaze (P < 0.001), and pain after reading (P < 0.001) were reduced significantly. Six months after the treatment, none of the mentioned symptoms was reported by the subjects. CONCLUSION: The findings revealed that noninvasive treatment (ibuprofen) has reduced eye pain, tenderness, and migraine headaches caused by trochleitis. What is important to mention is that trochleitis should be diagnosed properly.
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Abstract
PURPOSE OF REVIEW Eye pain is one of the most common presenting symptoms in ophthalmology. It can range from bothersome to debilitating for patients, and it can be vexing for clinicians, especially in the white and quiet eye. The purpose of this review is to provide updates of recent literature regarding eye pain and to communicate our current understanding regarding the evaluation and management of conditions that cause eye pain with a relatively normal examination. RECENT FINDINGS This review concerns recent literature regarding eye pain in the white and quiet eye. It is arranged by cause of pain and discusses dry eye syndrome, recurrent corneal erosion, postrefractive surgical pain, eye strain, intermittent angle closure, benign essential blepharospasm, trochleodynia, trochleitis and trochlear headache, and posterior scleritis. SUMMARY Eye pain in the white and quiet eye remains a difficult-to-navigate topic for practitioners. However, a careful history and focused physical examination can elucidate the diagnosis in many cases. Recent updates to the literature have advanced our knowledge of how to identify and treat the underlying causes of eye pain.
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Affiliation(s)
- Jerome Kulenkamp
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN
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7
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Lee SH, Kim DH, Yang HK. Acquired Brown Syndrome Secondary to Trochleitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.9.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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8
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Ojha P, Aglave V, Basak S, Yadav J. Failure to identify underlying autoimmunity and primary headache disorder might be the reasons for refractoriness of trochlear headaches. CEPHALALGIA REPORTS 2020. [DOI: 10.1177/2515816320951770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: A better understanding of etiology might improve poor outcomes of trochlear headaches (TRHs). Aims: To study clinical spectrum, etiology, and therapeutic response of TRH. Methods: Fifty-three TRH patients seen in a single center between 2015 and 2020 were included, excluding Trigeminal Autonomic Cephalalgia (TAC). Results: Mean age was 36.45 years (range 11–85 years), with 77.35% being females. Twenty-five patients had continuous trochlear headache (CTRH) and 28 episodic trochlear headache (ETRH). Tension-type headache (TTH) occurred in 9 ETRH patients and 24 of 25 CTRH patients, and migraine-like headaches occurred in 19 ETRH patients and 8 CTRH (trochlear migraine) patients. Prior history of headaches was noted in 22 of 28 ETRH and 11 of 25 CTRH patients. Twenty-eight responded to migraine/TTH prophylaxis, 25 being nonresponders (partial/no response). Fourteen of 25 nonresponders, 4 of 28 responders (4 of 4 secondary and 5 of 9 idiopathic trochleitis (IT), 3 of 9 primary TRH (PTRH), and 6 of 28 ETRH) had autoantibodies, that is, 11 antinuclear antibodies (ANAs) and 7 antithyroid antibodies. Ten of 14 (71.42%) antibody-positive nonresponders improved with immunosuppressants including steroids/hydroxychloroquine and only 11 required local injections. Finally, 38 patients had good response, 13 partial, and 2 no response. The etiology and refractoriness of IT can be attributed to underlying autoimmunity and a minor contribution by primary headaches, vice versa being the case for PTRH and ETRH. Refractory TRHs should be evaluated for underlying autoimmunity and primary headaches. Conclusion: Identification and treatment of underlying autoimmunity and primary headaches can help improve outcome of TRH.
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Affiliation(s)
- Pawan Ojha
- Department of Neurology, Hiranandani Hospital, Navi Mumbai, Maharashtra, India
| | - Vikram Aglave
- Department of Neurology, Government Grant Medical College, Mumbai, Maharashtra, India
| | - Suranjana Basak
- Department of Neurology, Hiranandani Hospital, Navi Mumbai, Maharashtra, India
| | - Jayendra Yadav
- Department of Neurology, Hiranandani Hospital, Navi Mumbai, Maharashtra, India
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Van Deun L, de Witte M, Goessens T, Halewyck S, Ketelaer MC, Matic M, Moens M, Vaes P, Van Lint M, Versijpt J. Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach. Eur Neurol 2020; 83:5-16. [PMID: 32222701 DOI: 10.1159/000505727] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/01/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Facial pain, alone or combined with other symptoms, is a frequent complaint. Moreover, it is a symptom situated at, more than any other pain condition, a crosspoint where several disciplines meet, for example, dentists; manual therapists; ophthalmologists; psychologists; and ear-nose-throat, pain, and internal medicine physicians besides neurologists and neurosurgeons. Recently, a new version of the most widely used classification system among neurologists for headache and facial pain, the International Classification of Headache Disorders, has been published. OBJECTIVE The aims of this study were to provide an overview of the most prevalent etiologies of facial pain and to provide a generic framework for the neurologist on how to manage patients presenting with facial pain. METHODS An overview of the different etiologies of facial pain is provided from the viewpoint of the respective clinical specialties that are confronted with facial pain. Key message: Caregivers should "think outside their own box" and refer to other disciplines when indicated. If not, a correct diagnosis can be delayed and unnecessary treatments might be given. The presented framework is aimed at excluding life- or organ-threatening diseases, providing several clinical clues and indications for technical investigations, and ultimately leading to the correct diagnosis and/or referral to other disciplines.
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Affiliation(s)
- Laura Van Deun
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Muriel de Witte
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Clinical Psychology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Thaïs Goessens
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Clinical Psychology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Stijn Halewyck
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Otorhinolaryngology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Marie-Christine Ketelaer
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium
| | - Milica Matic
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Anesthesiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Maarten Moens
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Neurosurgery, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Peter Vaes
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Manual Therapy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Michel Van Lint
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Ophthalmology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Jan Versijpt
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium, .,Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium,
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10
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A Relationship Between the Supratrochlear Nerve and Trochlea. J Craniofac Surg 2019; 30:2497-2498. [DOI: 10.1097/scs.0000000000005920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Primary trochlear headache. A periorbital pain with a specific diagnosis and treatment. ACTA ACUST UNITED AC 2019; 95:150-152. [PMID: 31627981 DOI: 10.1016/j.oftal.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 01/03/2023]
Abstract
Primary trochlear headache is a little-known cause of periorbital headache described in adults. It can involve very disabling pain. In addition, it can be associated with other types of headaches, making them even more difficult to identify. To diagnose this pathology, it is necessary that the examination of the trochlea be incorporated into the usual clinical practice of the patient with headache, which will allow the establishment of an adequate treatment. The case is presented of an adolescent patient with a diagnosis of migraine, who was admitted with a disabling headache secondary to a primary trochlear headache.
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Abstract
Transient disturbances in neurologic function are disturbing features of migraine attacks. Aura types include binocular visual, hemi-sensory, language and unilateral motor symptoms. Because of the gradual spreading quality of visual and sensory symptoms, they were thought to arise from the cerebral cortex. Motor symptoms previously included as a type of migraine aura were reclassified as a component of hemiplegic migraine. ICHD-3 criteria of the International Headache Society, added brainstem aura and retinal aura as separate subtypes. The susceptibility to all types of aura is likely to be included by complex and perhaps epigenetic factors.
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Affiliation(s)
- Rod Foroozan
- Baylor College of Medicine, 6565 Fannin NC-205, Houston, TX 77030, USA.
| | - F Michael Cutrer
- Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA
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13
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Tran TM, McClelland CM, Lee MS. Diagnosis and Management of Trochleodynia, Trochleitis, and Trochlear Headache. Front Neurol 2019; 10:361. [PMID: 31031693 PMCID: PMC6473032 DOI: 10.3389/fneur.2019.00361] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 03/25/2019] [Indexed: 11/13/2022] Open
Abstract
Migraine and tension-type headaches (TTHs) comprise a significant burden of neurological disease globally. Trochleodynia, also known as primary trochlear headache or trochleitis, may go unrecognized and contribute to worsening of these headache disorders. It may also present in isolation. We review the English literature on this under-recognized condition and describe what is known about the theorized pathophysiology, clinical presentation, and differential diagnosis. We also present a management algorithm for patients presenting with trochleodynia.
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Affiliation(s)
- Tu M Tran
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, United States
| | - Collin M McClelland
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, United States
| | - Michael S Lee
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, United States.,Department of Neurology, University of Minnesota, Minneapolis, MN, United States.,Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
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14
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Pediatric trochleitis associated with paranasal sinusitis: a case report. BMC Ophthalmol 2019; 19:16. [PMID: 30642284 PMCID: PMC6332564 DOI: 10.1186/s12886-019-1030-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Trochleitis is trochlear pain with evidence of inflammation in the trochlear area on radiologic examination. The etiology of trochleitis is mostly idiopathic. Secondary trochleitis is rare, and trochleitis associated with paranasal sinusitis in children has not yet been reported. Case presentation An 8-year-old boy presented with left periorbital pain for a week. His visual acuity and eye movement were normal. There was point tenderness on palpitation over the left trochlear region without swelling or redness. Orbital magnetic resonance imaging showed focal enhancement on the left trochlea and paranasal sinusitis on the left side. The patient’s symptoms and signs were completely resolved after empirical treatment for sinusitis. There was no need to inject a local steroid. Conclusion Although rare, sinusitis should be considered when diagnosing and treating trochleitis in children with periorbital pain.
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15
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Trochlear pain: clinical characteristics and treatment outcomes. J Neurol 2017; 265:376-380. [DOI: 10.1007/s00415-017-8713-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 11/27/2022]
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16
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Pareja JA, López-Ruiz P, Mayo D, Villar-Quiles RN, Cárcamo A, Gutiérrez-Viedma Á, Lastarria CP, Romeral M, Yangüela J, Cuadrado ML. Supratrochlear Neuralgia: A Prospective Case Series of 15 Patients. Headache 2017; 57:1433-1442. [PMID: 28833061 DOI: 10.1111/head.13158] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/11/2017] [Accepted: 04/11/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to describe clinical features unique to supratrochlear neuralgia. BACKGROUND The supratrochlear nerve supplies the medial aspect of the forehead. Due to the intricate relationship between supraorbital and supratrochlear nerves, neuralgic pain in this region has been traditionally attributed to supraorbital neuralgia. No cases of supratrochlear neuralgia have been reported so far. METHODS From 2009 through 2016, we prospectively recruited patients with pain confined to the territory of the supratrochlear nerve. RESULTS Fifteen patients (13 women, 2 men; mean age 51.4 years, standard deviation 14.9) presented with pain in the lower paramedian forehead, extending to the eyebrow in two patients and to the internal angle of the orbit in another. Pain was unilateral in 11 patients (six on the right, five on the left), and bilateral in four. Six patients had continuous pain and nine described intermittent pain. Palpation of the supratrochlear nerve at the medial third of the supraorbital rim resulted in hypersensitivity in all cases. All but one patient exhibited sensory disturbances within the painful area. Fourteen patients underwent anesthetic blockades of the supratrochlear nerve, with immediate relief in all cases and long-term remission in three. Six of them had received unsuccessful anesthetic blocks of the supraorbital nerve. Five patients were treated successfully with oral drugs and one patient was treated with radiofrequency. CONCLUSIONS Supratrochlear neuralgia is an uncommon disorder causing pain in the medial region of the forehead. It may be differentiated from supraorbital neuralgia and other similar headaches and neuralgias based on the topography of the pain and the response to anesthetic blockade.
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Affiliation(s)
- Juan A Pareja
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Pedro López-Ruiz
- Department of Neurology, Hospital Universitario Quironsalud Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Diego Mayo
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Rocío-Nur Villar-Quiles
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Alba Cárcamo
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.,Pain Clinic, Department of Anesthesiology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Álvaro Gutiérrez-Viedma
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Carlo P Lastarria
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
| | - María Romeral
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Julio Yangüela
- Department of Ophthalmology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - María-Luz Cuadrado
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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17
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Steroid intra-trochlear injection for the treatment of acquired Brown syndrome secondary to trochleitis. Graefes Arch Clin Exp Ophthalmol 2017; 255:2045-2050. [DOI: 10.1007/s00417-017-3757-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/30/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022] Open
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18
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Cachinero-Torre A, Díaz-Pulido B, Asúnsolo-Del-Barco Á. Relationship of the Lateral Rectus Muscle, the Supraorbital Nerve, and Binocular Coordination with Episodic Tension-Type Headaches Frequently Associated with Visual Effort. PAIN MEDICINE 2017; 18:969-979. [PMID: 28122939 DOI: 10.1093/pm/pnw292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective To study the relationship between tension-type headaches and the oculomotor system in terms of binocular coordination, mechanosensitivity of the supraorbital nerve, and myofascial trigger points in the lateral rectus muscle, assessing the influence of visual effort caused by using a computer at work. Design Observational study with blind evaluation of the response variable. Methods Two groups were compared: 19 subjects with tension-type headaches and 16 healthy subjects, both exposed to computer use at work. A blinded assessor conducted three tests: measurement of the supraorbital nerve pressure pain threshold using a pressure algometer, evaluation of myofascial trigger points of the lateral rectus using the verbal numerical scale, and assessment of binocular coordination in smooth pursuit eye movements using an innovative video-oculography system. Tests were performed before work began and four hours later, and subjects in the headache group were examined when they presented a headache score of less than or equal to 3 on the verbal numerical scale. Results The headache group presented a greater sensitivity of the supraorbital nerve and greater local and referred pain of the lateral rectus ( P < 0.05). Visual effort caused a significant worsening of these variables in both groups. However, binocular coordination after visual effort was only significantly affected in the headache group ( P < 0.05), primarily in horizontal movements. Conclusions The finding of a higher alteration of the sensitivity of the supraorbital nerve, the myofascial trigger points of the lateral rectus, binocular coordination, and the significant influence of visual effort in patients with tension-type headaches suggest a new clinical perspective for problems related to tension-type headaches.
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Affiliation(s)
| | - Belén Díaz-Pulido
- Department of Nursing and Physiotherapy, University of Alcalá, Alcalá de Henares, Madrid, Spain
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19
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Jarrín E, García-García Á, Hurtado-Ceña FJ, Rodríguez-Sánchez JM. Clinical Characteristics, Treatment, and Outcome of Trochleitis. Strabismus 2017; 25:1-4. [DOI: 10.1080/09273972.2016.1276936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Elena Jarrín
- Ophthalmology Department, Rey Juan Carlos Hospital, Madrid, Spain
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20
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Villar-Quiles RN, García-Moreno H, Mayo D, Gutiérrez-Viedma Á, Ramos MI, Casas-Limón J, Cuadrado ML. Infratrochlear neuralgia: A prospective series of seven patients treated with infratrochlear nerve blocks. Cephalalgia 2017; 38:585-591. [PMID: 28114806 DOI: 10.1177/0333102417690493] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Infratrochlear neuralgia is a recently described painful cranial neuropathy that causes pain in the internal angle of the orbit and the medial upper eyelid, the upper bridge of the nose and/or the lacrimal caruncle. We aim to present seven new cases of infratrochlear neuralgia treated with anaesthetic nerve blocks. Methods Over an 18-month period, we prospectively identified seven cases of infratrochlear neuralgia among the patients attending the Headache Unit in a tertiary hospital. Anaesthetic blocks were performed by injecting 0.5 cc of bupivacaine 0.5% at the emergence of the nerve above the internal canthus. Results All patients were women, and the mean age was 49.1 years (standard deviation, 17.9). The pain appeared at the internal angle of the orbit and/or the medial upper eyelid in six cases, and the whole territory of the infratrochlear nerve in one case. Six patients had continuous pain and one had episodes lasting 8-24 hours. All patients showed sensory disturbances within the painful area and tenderness upon palpation of the infratrochlear nerve. Nerve blocks resulted in complete and long-lasting relief in four patients and short-lasting relief in the other three patients. Conclusions Infratrochlear neuralgia should be considered among the neuralgic causes of orbital and periorbital pain. Anaesthetic blocks may assist clinicians in the diagnosis and may also be an effective therapy.
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Affiliation(s)
- Rocío-Nur Villar-Quiles
- 1 Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,2 Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Héctor García-Moreno
- 1 Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,3 Department of Molecular Neuroscience, University College London (UCL), London, UK
| | - Diego Mayo
- 1 Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,2 Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Álvaro Gutiérrez-Viedma
- 1 Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,2 Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | | | - Javier Casas-Limón
- 5 Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - María-Luz Cuadrado
- 1 Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,2 Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
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21
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Volcy M, Rapoport AM, Tepper SJ, Sheftell FD, Bigal ME. Persistent Idiopathic Facial Pain Responsive to Topiramate. Cephalalgia 2016; 26:489-91. [PMID: 16556253 DOI: 10.1111/j.1468-2982.2006.01036.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M Volcy
- The New England Center for Headache, Stamford, CT 06902, USA
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22
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Maggioni F, Mainardi F, Dainese F, Lisotto C, Zanchin G. Migraine Secondary to Superior Oblique Myokymia. Cephalalgia 2016; 27:1283-5. [PMID: 17692104 DOI: 10.1111/j.1468-2982.2007.01422.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F Maggioni
- Headache Centre, Department of Neurosciences, University of Padua, Padua, Italy.
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23
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Pego-Reigosa R, Vázquez-López ME, Iglesias-Gómez S, Martínez-Vázquez FM. Association between Chronic Paroxysmal Hemicrania and Primary Trochlear Headache: Pathophysiology and Treatment. Cephalalgia 2016; 26:1252-4. [PMID: 16961797 DOI: 10.1111/j.1468-2982.2006.01202.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R Pego-Reigosa
- Neurology Department, Complejo Hospitalario Xeral-Calde, C/Severo Ochoa sn, Lugo, Spain.
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24
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Pareja JA, Casanova I, Arbex A, Cuadrado ML. Infratrochlear neuralgia. Cephalalgia 2015; 35:1202-7. [PMID: 25787686 DOI: 10.1177/0333102415578429] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/25/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The infratrochlear nerve supplies the medial aspect of the upper eyelid, the superolateral aspect of the nose and the lacrimal caruncle. This nerve may contribute to the pain stemming from the trochlea, but infratrochlear neuralgia has not been identified as a specific cause of pain. METHODS Over a 10-year period we have been recruiting patients with pain in the internal angle of the orbit that did not show features of trochlear pain. RESULTS Seven patients (six female, one male; mean age, 46.1 ± 18.9) presented with pain in the territory of the infratrochlear nerve. The pain appeared in the internal angle of the orbit and upper eyelid (n = 3), the superolateral aspect of the nose (n = 3), or the lacrimal caruncle (n = 1). All patients had a paroxysmal pain, with the attacks lasting five to 30 seconds. Pain attacks were mostly spontaneous, but two patients had triggers. Between attacks, all patients had local allodynia. Pain did not increase with vertical eye movements. Six patients were treated with gabapentin with complete response, and one patient experienced long-lasting relief with an anesthetic blockade of the infratrochlear nerve. CONCLUSION Infratrochlear neuralgia should be considered as a possible cause of pain in the internal angle of the orbit.
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Affiliation(s)
- Juan A Pareja
- Neurology Department, University Hospital Quirón Madrid, Pozuelo de Alarcón, Madrid, Spain Neurology Department, University Hospital Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Ignacio Casanova
- Neurology Department, University Hospital Quirón Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Andrea Arbex
- Neurology Department, University Hospital Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - María L Cuadrado
- Neurology Department, Hospital Clínico San Carlos, Complutense University, Madrid, Spain
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25
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Armbrust KR, Kosmorsky GS, Lee MS, Friedman DI. A pain in the eye. Surv Ophthalmol 2014; 59:474-7. [PMID: 24837852 DOI: 10.1016/j.survophthal.2013.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 10/16/2013] [Indexed: 11/29/2022]
Abstract
A 38-year-old woman presented with chronic left retro-orbital pain and photophobia. Palpation of the left occipital prominence revealed tenderness in the area of the greater occipital nerve and reproduced the eye pain. The diagnosis of cervicogenic headache was confirmed by symptom resolution following left greater occipital nerve blockade. The functional association between the greater occipital nerve and the trigeminal nerve provides a potential mechanism for this case of cervicogenic eye pain.
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Affiliation(s)
- Karen R Armbrust
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | | | - Michael S Lee
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota; Department of Neurology, University of Minnesota, Minneapolis, Minnesota; Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota.
| | - Deborah I Friedman
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
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26
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Smith JH, Garrity JA, Boes CJ. Clinical features and long-term prognosis of trochlear headaches. Eur J Neurol 2013; 21:577-85. [PMID: 24261483 DOI: 10.1111/ene.12312] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/21/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Trochlear headaches are a recently recognized cause of headache, of which both primary and inflammatory subtypes are recognized. The clinical features, long-term prognosis and optimal treatment strategy have not been well defined. METHODS A cohort of 25 patients with trochlear headache seen at the Mayo Clinic between 10 July 2007 and 28 June 2012 were identified. RESULTS The diagnosis of trochlear headache was not recognized by the referring neurologist or ophthalmologist in any case. Patients most often presented with a new daily from onset headache (n = 22, 88%). The most characteristic headache syndrome was reported as continuous, achy, periorbital pain associated with photophobia and aggravation by eye movement, especially reading. Individuals with a prior history of migraine were likely to have associated nausea and experience trochlear migraine. Amongst individuals with trochleitis, 5/12 (41.6%) had an identified secondary mechanism. Treatment responses were generally, but not invariably, favorable to dexamethasone/lidocaine injections near the trochlea. At a median follow-up of 34 months (range 0-68), 10/25 (40%) of the cohort had experienced complete remission. CONCLUSIONS Trochlear headaches are poorly recognized, have characteristic clinical features, and often require serial injections to optimize the treatment outcome. The identification of trochleitis should prompt neuroimaging to look for a secondary cause.
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Affiliation(s)
- J H Smith
- Department of Neurology, University of Kentucky, Lexington, KY, USA
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27
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Lee KJ, Jeong SH, Lee YH, Lee AY, Kim JM, Hwang JM, Kim JS. Fourth nerve palsy presenting with trochleodynia. J Neurol 2013; 260:677-9. [PMID: 23322034 DOI: 10.1007/s00415-012-6781-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/28/2012] [Accepted: 11/29/2012] [Indexed: 11/30/2022]
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Guerrero ÁL, Herrero-Velázquez S, Peñas ML, Mulero P, Pedraza MI, Cortijo E, Fernández R. Peripheral nerve blocks: a therapeutic alternative for hemicrania continua. Cephalalgia 2012; 32:505-8. [DOI: 10.1177/0333102412439800] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: A complete response to indomethacin is required for the diagnosis of hemicrania continua (HC). Nevertheless, patients may develop side effects leading to withdrawal of this drug. Several alternatives have been proposed with no consistent effectiveness. Both anaesthetic blocks of peripheral nerves and trochlear corticosteroid injections have been effective in some case reports. Methods: Twenty-two patients with HC were assessed in a headache outpatient office. Physical examination included palpation of the supraorbital nerve (SON) and greater occipital nerve (GON) as well as of the trochlear area. Results: In 14 patients, at least one tender point was detected. Due to indomethacin intolerance, at least one anaesthetic block of the GON or SON, or an injection of corticosteroids in the trochlear area, were performed in nine patients. Four of them were treated with a combination procedure. All these patients experienced total or partial improvement lasting from 2 to 10 months. Conclusion: Anaesthetic blocks or corticosteroid injections may be effective in HC patients showing tenderness of the SON, GON or trochlear area.
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Affiliation(s)
- Ángel L Guerrero
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | | | - María L Peñas
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Patricia Mulero
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Elisa Cortijo
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Rosa Fernández
- Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
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Ringeisen AL, Harrison AR, Lee MS. Ocular and orbital pain for the headache specialist. Curr Neurol Neurosci Rep 2011; 11:156-63. [PMID: 21128023 DOI: 10.1007/s11910-010-0167-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ocular pain is most commonly associated with redness and inflammation; however, eye pain can also occur in the absence of grossly visible pathology. Pain in the quiet eye can be the first sign of a number of threatening conditions. Many of these conditions such as intermittent angle closure glaucoma, carotid artery dissection, idiopathic intracranial hypertension, and giant cell arteritis can lead to permanent vision loss or blindness. In this review, ocular history and examination techniques are summarized. The article also reviews pertinent ocular, orbital, referred, and other causes of eye pain in the quiet eye. The neurologist and headache specialist should recognize when consultation with an ophthalmologist is necessary.
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Affiliation(s)
- Alexander L Ringeisen
- Department of Ophthalmology, University of Minnesota, 420 Delaware Street SE, MMC 493, Minneapolis, MN 55455, USA
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Abstract
Sensory innervation to the eye and periocular area arises from the ophthalmic branch of the trigeminal nerve. Thus, ocular, orbital, and systemic disorders may produce head pain with ocular signs and symptoms. Whereas some of these entities have characteristic diagnostic features, others mimic primary headache disorders such as migraine and cluster headache. This article reviews common ocular and neuro-ophthalmic conditions that are accompanied by pain in or near the eye.
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32
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33
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Headache, facial pain, and disorders of facial sensation. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cuadrado ML, Porta-Etessam J, Pareja JA, Matías-Guiu J. Hemicrania continua responsive to trochlear injection of corticosteroids. Cephalalgia 2009; 30:373-4. [DOI: 10.1111/j.1468-2982.2009.01905.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- ML Cuadrado
- Department of Neurology, Hospital Clínico San Carlos and Universidad Complutense, Alcorcón, Madrid, Spain
| | - J Porta-Etessam
- Department of Neurology, Hospital Clínico San Carlos and Universidad Complutense, Alcorcón, Madrid, Spain
| | - JA Pareja
- Department of Neurology, Hospital Universitario Fundación Alcorcón and Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - J Matías-Guiu
- Department of Neurology, Hospital Clínico San Carlos and Universidad Complutense, Alcorcón, Madrid, Spain
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Zaragoza-Casares P, Gómez-Fernández T, de Liaño MAZG, Zaragoza-Garcia P. Bilateral Idiopathic Trochleitis as a Cause of Frontal Cephalgia. Headache 2009; 49:476-7. [DOI: 10.1111/j.1526-4610.2008.01259.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The role of extraocular and facial muscle trigger points in cephalalgia. Curr Pain Headache Rep 2008; 12:350-4. [PMID: 18765140 DOI: 10.1007/s11916-008-0059-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Trigger points play a part in the development and maintenance of chronic headache states. This article reviews the physiology of trigger points, with a focus on the -latest understanding of their biochemistry. The importance of facial muscle and extraocular muscle trigger points is only beginning to be understood; the data exploring their role in headache are reviewed. The concept of central sensitization and the way in which it relates to trigger points and headache is explained, along with treatment strategies for helping patients with their pain.
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Fernandez de las Peñas C, Cuadrado ML, Gerwin RD, Pareja JA. Referred Pain From the Trochlear Region in Tension‐Type Headache: A Myofascial Trigger Point From the Superior Oblique Muscle. Headache 2008; 45:731-7. [PMID: 15953305 DOI: 10.1111/j.1526-4610.2005.05140.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tension-type headache (TTH) is a prototypical headache in which myofascial trigger points (MTrPs) can play an important role. To our knowledge, MTrPs in the muscle tissues of the trochlear region, ie, the superior oblique muscle (SOM), have not been previously mentioned, and a referred pain pattern from this region has never been reported. OBJECTIVE To describe the referred pain from the trochlear area based on the examination of MTrPs in the SOM in patients with episodic and chronic TTH (CTTH). DESIGN A blinded, controlled study. METHODS The trochlear region was examined in 15 patients with CTTH, 15 patients with episodic TTH (ETTH), and 15 control subjects. Referred pain elicited by different maneuvers performed during manual palpation, ie, maintained pressure, active muscle contraction, and stretching of the muscle, was assessed with a visual analogue scale. Patients with ETTH were examined on days when they were headache-free, whereas CTTH patients were examined on days in which headache intensity was less than 4 points on a 10-cm horizontal visual analogue scale. RESULTS Eighty-six percent of patients with CTTH and 60% with ETTH had referred pain that originated from MTrPs in the SOM, while only 27% of the controls reported referred pain. This pain was perceived as a deep ache located at the retro-orbital region, sometimes extending to the supra-orbital region or the homo-lateral forehead. Pain intensity was greater in CTTH patients than in ETTH patients or control subjects (P < .001). CONCLUSIONS MTrPs in the SOM may evoke a typical referred pain pattern in patients with TTH. The presence of a myofascial disorder in the trochlear region might contribute to the pathogenesis of TTH.
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Affiliation(s)
- Cesar Fernandez de las Peñas
- Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Avenida de Atenas s/n 28922, Alcorcón, Madrid, Spain
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Fernández-de-Las-Peñas C, Cuadrado ML, Gerwin RD, Pareja JA. Referred pain elicited by manual exploration of the lateral rectus muscle in chronic tension-type headache. PAIN MEDICINE 2008; 10:43-8. [PMID: 18346068 DOI: 10.1111/j.1526-4637.2008.00416.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To analyze the presence of referred pain elicited by manual examination of the lateral rectus muscle in patients with chronic tension-type headache (CTTH). DESIGN A case-control blinded study. SETTING It has been found previously that the manual examination of the superior oblique muscle can elicit referred pain to the head in some patients with migraine or tension-type headache. However, a referred pain from other extraocular muscles has not been investigated. METHODS Fifteen patients with CTTH and 15 healthy subjects without headache history were included. A blinded assessor performed a manual examination focused on the search for myofascial trigger points (TrPs) in the right and left lateral rectus muscles. TrP diagnosis was made when there was referred pain evoked by maintained pressure on the lateral corner of the orbit (anatomical projection of the lateral rectus muscle) for 20 seconds, and increased referred pain while the subject maintained a medial gaze on the corresponding side (active stretching of the muscle) for 15 seconds. On each side, a 10-point numerical pain rate scale was used to assess the intensity of referred pain at both stages of the examination. RESULTS Ten patients with CTTH (66.6%) had referred pain that satisfied TrPs diagnostic criteria, while only one healthy control (0.07%) reported referred pain upon the examination of the lateral rectus muscles (P < 0.001). The elicited referred pain was perceived as a deep ache located at the supraorbital region or the homolateral forehead. Pain was evoked on both sides in all subjects with TrPs, with no difference in pain intensity between the right and the left. The average pain intensity was significantly greater in the patient group (P < 0.001). All CTTH patients with referred pain recognized it as the frontal pain that they usually experienced during their headache attacks, which was consistent with active TrPs. CONCLUSION In some patients with CTTH, the manual examination of lateral rectus muscle TrPs elicits a referred pain that extends to the supraorbital region or the homolateral forehead. Nociceptive inputs from the extraocular muscles may sustain the activation of trigeminal neuron, thus sensitizing central pain pathways and exacerbating headache.
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Pareja JA, Sánchez del Río M. Primary trochlear headache and other trochlear painful disorders. Curr Pain Headache Rep 2006; 10:316-20. [PMID: 16834949 DOI: 10.1007/s11916-006-0039-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The trochlear region is a source of distinct pain that may give rise to specific primary pain disorders (primary trochlear headache), but also modulate other pre-existing headache disorders such as migraine. The sensory innervation of this region, by a branch of the ophthalmic division of the trigeminal nerve, may explain the modulatory influence of the nociceptive afferents of this region over migraine headache. We propose the term "trochlear migraine" to refer to the coexistence of strictly unilateral migraine and ipsilateral trochleodynia, with the improvement of migraine being dependent on the resolution of the trochleodynia. Trochleitis is an inflammatory trochleodynia, being frequently idiopathic and rarely secondary to usually immunologic and rheumatologic disorders. We postulate that nociceptive afferents from the inner part of the orbit may sustain the activation of trigeminal neurons, thus sensitizing or exacerbating migraine. Decreasing the possible wind-up induced from this nociceptive afferent stimulation may be effective in controlling headache.
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Affiliation(s)
- Juan A Pareja
- Department of Neurology, Fundación Hospital Alcorcón, Madrid, Spain.
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40
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Fernández-de-Las-Peñas C, Cuadrado ML, Gerwin RD, Pareja JA. Myofascial disorders in the trochlear region in unilateral migraine: a possible initiating or perpetuating factor. Clin J Pain 2006; 22:548-53. [PMID: 16788342 DOI: 10.1097/01.ajp.0000210697.53874.cb] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Some patients with trochlear disorders have been found to suffer from concurrent migraine. However, a trochlear examination is not systematically done in patients with migraine. Moreover, a search for myofascial trigger points in the superior oblique muscle has never been reported in these patients. METHODS The trochlear region was examined in 20 participants with strictly unilateral migraine without side-shift and in 20 controls. Referred pain elicited by different maneuvers during manual palpation (ie, maintained pressure, active muscle contraction, and stretching of the superior oblique muscle) was assessed with a visual analog scale. All participants were headache free on the day of evaluation. RESULTS Sixteen participants with migraine (80%) perceived referred pain on examination of the trochlear area. It was described as a tightening sensation in the retro-orbital region, sometimes extending to the supraorbital region and the homolateral forehead. In 15 participants with migraine, both the active contraction and the stretching of the muscle increased the referred pain, which was consistent with definite myofascial trigger points. All the definite trigger points were ipsilateral to the side of the headache. Conversely, only 5 controls (20%) had referred pain. None of them had definite myofascial trigger points because muscle stretching did not increase the intensity of pain. The intensity of referred pain at each stage of the trochlear examination was greater in subjects with migraine than in controls (P<0.001). CONCLUSION Patients with unilateral migraine commonly perceive referred pain from the trochlear area that probably comes from the myofascial trigger points. Myofascial disorders in the trochlear region might contribute to the perpetuation of concomitant migraine.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
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41
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Abstract
Supraorbital neuralgia is a rare disorder clinically characterized by the following triad: 1) forehead pain in the territory supplied by the supraorbital nerve, without side shift; 2) tenderness on either the supraorbital notch or traject of the nerve; and 3) absolute, but transitory relief of symptoms upon supraorbital nerve blockade. The pain presents with a chronic or intermittent pattern. In addition, there may be signs and symptoms of sensory dysfunction (hypoesthesia, paresthesia and allodynia), and typical "neuralgic features" (lightning pain and exteroceptive precipitating mechanisms). However, sensitive and neuralgic features are not constantly present and seem to be more frequent in the secondary, usually post-traumatic, forms.
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Affiliation(s)
- Juan A Pareja
- Department of Neurology, Fundación Hospital Alcorcón, Madrid, Spain.
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42
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Abstract
Differential diagnosis of pain in the face as the presenting complaint can be difficult. We propose an approach based on history and neurological examination, which allows a working diagnosis to be made at the bedside, including aetiological hypotheses, leading to a choice of investigations. Neuralgias are characterised by stabs of short lasting, lancinating pain, and, although neuralgias are often primary, imaging may be needed to exclude symptomatic forms. Facial pain with cranial nerve symptoms and signs is almost exclusively of secondary origin and requires urgent examination. Facial pain with focal autonomic signs is mostly primary and belongs to the group of the idiopathic trigeminal autonomic cephalalgias, but can occasionally be secondary. Pure facial pain is most often due to sinusitis and the chewing apparatus, but also a multitude of other causes. The pain can also be idiopathic. Imaging as well as non-neurological specialist assessment is often necessary in these cases.
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Affiliation(s)
- Massimiliano M Siccoli
- Neurology Department, University Hospital, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
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43
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Abstract
There is a close relationship between headache and the visual system. Visual symptoms are prominent features of clinical syndromes such as migraine, cluster headache, and the trigeminal autonomic cephalgias. There are also strong links between headache and the visual system on the basis of genetics, molecular biology, neurophysiology, and neuroimaging. Studies of these links are leading to the development of novel therapies for a variety of headache syndromes. This review is designed to summarize the most recent literature on headache and the visual system. A particular emphasis is placed on publications of interest to clinicians.
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Affiliation(s)
- Charles E Maxner
- Room 3819, Halifax Infirmary, Queen Elizabeth II Health Sciences Centre, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada.
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