Carotidynia as a form of presentation of paroxysmal hemicrania
Introduction. Paroxysmal hemicrania is a well-defined clinical condition about which many articles have been published. Attempts have been made to explain the response of this illness to indomethacin, suggesting its possible cervical origin. In some patients it is set off by stimulation of certain trigger zones situated in this region. The exceptional radiation of the pain seen in our patient clearly supports this theory. Clinical case. A 34 year old man with a past history of a similar but briefer episode 5 years previously presented to us. He complained of repeated episodes of stabbing pain with no obvious cause. The pain started at the base of the neck and radiated along the right carotid vessels to the cheek, base of the nose and ipsilateral eye. This was accompanied by injection of the conjunctivae, tears, nasal congestion and nasal discharge. Each episode lasted 15 to 30 minutes and was repeated 20 to 25 times a day without any particular relation to the time of day. The neurological examination, MR and angio-MR were normal. Before being seen by us he had been treated with prednisone and verpamil without effect. Indomethacin at a dose of 100 mg/day controlled the problem completely. Conclusions. We report a case of paroxysmal hemicrania with a spontaneous description of pain starting at the base of the neck and radiating along the carotid vessels. We consider this clinical description to be of interest since it supports the theories of a cervicogenic origin of this type of headache.
Caso clínico Varón de 34 años con el antecedente de un episodio de similares características y menor duración cinco años antes del proceso que nos ocupa. Consultó por episodios repetidos de dolor lancinante sin desencadenantes apreciables. El dolor se originaba en la base del cuello, irradiándose por el trayecto carotídeo derecho hasta la mejilla, raíz nasal y ojo ipsilaterales, y se acompañaba de inyección conjuntival, lagrimeo, congestión nasal y rinorrea. Cada brote duró entre 15 y 30 minutos, y se repitió de 20 a 25 veces al día, sin dominancias horarias aparentes. La exploración neurológica, RM y angio-RM fueron normales. Antes de llegar a nuestra consulta recibió tratamientos con prednisona y verapamilo sin efecto apreciable. La indometacina en dosis de 100 mg diarios logró el control absoluto del cuadro.
Conclusiones Aportamos un caso de hemicránea paroxística con una descripción espontánea de dolor originado en la base del cuello, e irradiado por el trayecto carotídeo. Creemos de interés esta descripción clínica ya que apoya las teorías del origen cervicogénico de este tipo de cefalea
