Rare Primary Headaches
Rare Primary Headaches
Epicrania fugax was first described in 2008 and is characterized by attacks of brief paroxysmal stabbing, moderate to severe head pain that usually starts at the posterior scalp and rapidly radiates towards the frontal part of the head, the eye or nose in a linear or zig-zag trajectory. Backward epicrania fugax starting from the forehead was described in some patients. Start and finish of this line belongs to a different nerve innervation territory. The pain is almost always unilateral, even though side shifts are possible. Attack frequency is extremely variable and ranges from few attacks per year to several attacks per day. Attack duration is usually between 1 and 15 s. Attacks can be triggered in some patients by touching the affected point of onset. This area may also remain tender between attacks. Other triggers were neck or eye movements, coughing, straining, Valsalva manoeuvres as well as emotional stress. Sixty-six patients were described in the literature so far. There appears to be a female preponderance of 2 : 1 and age of onset is variable between 23 and 84 years. Effective treatment attempts were performed using gabapentin (900–1200 mg/day), pregabalin (50–150 mg/day), lamotrigine (100 mg/day), levetiracetam (500 mg/day) and indometacin (75 mg/day). Successful invasive procedures included greater occipital nerve (GON) blockade (2 cm bupivacaine 5% alone and in combination with triamcinolone) as well as GON and supraorbital nerve (SON) blockade.
Epicrania Fugax
Epicrania fugax was first described in 2008 and is characterized by attacks of brief paroxysmal stabbing, moderate to severe head pain that usually starts at the posterior scalp and rapidly radiates towards the frontal part of the head, the eye or nose in a linear or zig-zag trajectory. Backward epicrania fugax starting from the forehead was described in some patients. Start and finish of this line belongs to a different nerve innervation territory. The pain is almost always unilateral, even though side shifts are possible. Attack frequency is extremely variable and ranges from few attacks per year to several attacks per day. Attack duration is usually between 1 and 15 s. Attacks can be triggered in some patients by touching the affected point of onset. This area may also remain tender between attacks. Other triggers were neck or eye movements, coughing, straining, Valsalva manoeuvres as well as emotional stress. Sixty-six patients were described in the literature so far. There appears to be a female preponderance of 2 : 1 and age of onset is variable between 23 and 84 years. Effective treatment attempts were performed using gabapentin (900–1200 mg/day), pregabalin (50–150 mg/day), lamotrigine (100 mg/day), levetiracetam (500 mg/day) and indometacin (75 mg/day). Successful invasive procedures included greater occipital nerve (GON) blockade (2 cm bupivacaine 5% alone and in combination with triamcinolone) as well as GON and supraorbital nerve (SON) blockade.
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