A multidirectional epicrania fugax

Background Epicrania fugax consists of brief paroxysms of pain, which radiate in a line or in zigzag trajectory across the surface of the scalp or the face. Methods A prospective, descriptive study was performed in five patients presenting with an epicrania fugax-type pain with extracephalic irradiation. Results All patients were women, and the mean age at onset was 59.8 (standard deviation, 10.9). They had unilateral paroxysms of electrical pain starting at a particular point in the head (parietal, n = 3; vertex, n = 1; frontal, n = 1) and rapidly radiating downwards in a lineal trajectory to reach extracephalic regions (ipsilateral limbs, n = 2; shoulder, n = 2; low neck, n = 1) in 1–3 seconds. Pain intensity was moderate or severe. Three patients had nummular headache at the point where the paroxysms originated. One patient had spontaneous remission, and four patients achieved complete or almost complete response with therapy (onabotulinumtoxinA, n = 2; indomethacin, n = 1; amitriptyline, n = 1; lamotrigine, n = 1). Conclusion The spectrum of epicrania fugax may include paroxysms with extracephalic irradiation. The propagation of pain beyond the head and the face supports the involvement of central mechanisms in the pathophysiology of this entity.

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Epicrania Fugax with a Novel Sign: Pain Paroxysms with Parallel Forward or Backward Trajectories

Pain Medicine ◽

10.1093/pm/pnz239 ◽

2019 ◽

Vol 21 (4) ◽

pp. 873-875 ◽

Cited By ~ 1

Author(s):

Yu-hong Man ◽

Jing-jing Qi ◽

Ting-min Yu ◽

Gang Yao

Keyword(s):

Backward Trajectories ◽

Epicrania Fugax

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Epicrania Fugax

Current Pain and Headache Reports ◽

10.1007/s11916-016-0557-9 ◽

2016 ◽

Vol 20 (4) ◽

Cited By ~ 12

Author(s):

María Luz Cuadrado ◽

Angel L. Guerrero ◽

Juan A. Pareja

Keyword(s):

Epicrania Fugax

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Epicrania fugax: Report of eight cases with some novel features

Cephalalgia Reports ◽

10.1177/2515816320946492 ◽

2020 ◽

Vol 3 ◽

pp. 251581632094649

Author(s):

Debashish Chowdhury ◽

Tanushree Chawla ◽

Ashish Duggal

Keyword(s):

Age Of Onset ◽

Delayed Diagnosis ◽

Case Series ◽

Visual Analog Scale Score ◽

Headache Disorder ◽

Medical Intervention ◽

Linear Distribution ◽

Duration Of Symptoms ◽

Epicrania Fugax ◽

The Mean

Introduction: Epicrania fugax (EF) is an epicranial headache syndrome characterized by short lasting headache paroxysms which spread in a typical linear/zigzag pattern. The definition of EF has evolved over time, and new phenotypes have been observed in various studies. Aim: We present eight cases diagnosed as EF according to the International Classification of Headaches Disorders, 3rd edition criteria and highlight certain novel characteristics which will help in the further categorization of this disorder. Methods: We prospectively studied eight cases of EF who presented to our headache clinic from January 2016 to September 2020. Demographic and detailed clinical data were collected and analyzed. Results: The mean age of onset of the cohort was 42 ± 10.47 years with a median duration of symptoms being 1 year. There were 5 male and 3 female patients. The mean visual analog scale score was 5.25 ± 1.83. Headache frequency had high intra and interindividual variability. Four patients had a typical spread of pain along the distribution of greater occipital, and supraorbital, nerves. Four patients had an atypical presentation with midline headache, transverse occipital, and bilateral simultaneous hemicranium involvement. Headache paroxysm was followed by a prolonged fixed pain in the same linear distribution in three patients. One patient had ipsilateral redness in the eye. All eight patients required medical intervention with amitriptyline or neuromodulators, five of whom reported a significant reduction in their headache symptoms. Conclusion: Our case series highlights a few interesting features which need further exploration with larger studies. Firstly, the atypical distribution of the pain trajectory forces us to dig deeper into the pathogenesis of the disorder. Secondly, our data also suggest a possibility of EF triggered “linear headaches.” EF is a relatively uncommon headache disorder that can be managed easily with neuromodulators but the lack of awareness of the condition often leads to delayed diagnosis.

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Epicrania Fugax: An Ultrabrief Paroxysmal Epicranial Pain

Cephalalgia ◽

10.1111/j.1468-2982.2007.01515.x ◽

2008 ◽

Vol 28 (3) ◽

pp. 257-263 ◽

Cited By ~ 53

Author(s):

JA Pareja ◽

ML Cuadrado ◽

C Fernández-de-las-Peñas ◽

AB Caminero ◽

C Nieto ◽

...

Keyword(s):

Clinical Picture ◽

Temporal Pattern ◽

Complete Sequence ◽

Temporal Region ◽

Head Pain ◽

Focal Area ◽

Epicrania Fugax ◽

Posterior Parietal

Ten patients (one man and nine women, mean age 48.8 ± 20.1) presented with a stereotypical and undescribed type of head pain. They complained of strictly unilateral, shooting pain paroxysms starting in a focal area of the posterior parietal or temporal region and rapidly spreading forward to the ipsilateral eye ( n = 7) or nose ( n = 3) along a lineal or zigzag trajectory, the complete sequence lasting 1-10 s. Two patients had ipsilateral lacrimation, and one had rhinorrhoea at the end of the attacks. The attacks could be either spontaneous or triggered by touch on the stemming area ( n = 2), which could otherwise remain tender or slightly painful between the paroxysms ( n = 5). The frequency ranged from two attacks per month to countless attacks per day, and the temporal pattern was either remitting ( n = 5) or chronic ( n = 5). This clinical picture might be a variant of an established headache or represent a novel syndrome.

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Linear interictal pain in Epicrania Fugax

The Journal of Headache and Pain ◽

10.1186/s10194-015-0507-7 ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 7

Author(s):

Juan A Pareja ◽

Pablo Bandrés

Keyword(s):

Epicrania Fugax

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Case report: Wallenberg’s syndrome, a possible cause of symptomatic epicrania fugax

Cephalalgia ◽

10.1177/0333102417726334 ◽

2017 ◽

Vol 38 (6) ◽

pp. 1203-1206 ◽

Cited By ~ 4

Author(s):

Alex Jaimes ◽

Rafael García-Sáez ◽

Álvaro Gutiérrez-Viedma ◽

María-Luz Cuadrado

Keyword(s):

Case Report ◽

Primary Headache ◽

Skull Base Meningioma ◽

Wallenberg’S Syndrome ◽

Wallenberg's Syndrome ◽

Epicrania Fugax ◽

The Right ◽

The Temple ◽

Possible Cause ◽

Symptomatic Form

Background Epicrania fugax has been described as a primary headache. Nevertheless, a symptomatic form was recently found in a patient with a skull base meningioma abutting the trigeminal nerve. Here we report on a patient with facial pain with the features of epicrania fugax occurring after Wallenberg’s syndrome. Case report A 53-year-old man suffered a right-sided dorsolateral medullary ischaemic stroke. Nine months later, he presented with brief electric shock-like paroxysms of pain stemming from the right eye and radiating to the ipsilateral forehead, the temple or the cheek in a zigzag trajectory. Some episodes were accompanied by ipsilateral conjunctival injection and eyelid oedema. Treatment with eslicarbazepine abolished the pain. Conclusion A pain with the features of epicrania fugax may be associated with medullary lesions. This finding suggests that the central trigeminal pathways and/or the spinal trigeminal nucleus may play an important role in the pathophysiology of this type of pain.

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