A recurrent headache circumscribed in a coronal line-shaped area around the head: a coronal linear headache

Abstract

BackgroundLinear headache (LH) has recently been described as a paroxysmal or continuous head pain restricted in a linear trajectory of 5–10 mm in width, linking one endpoint in occipital or occipitocervical region with another endpoint in ipsilateral nasion or forehead region. The sagittal line-shaped pain area of LH is close and parallel to a sagittal venous sinus, the superior sagittal sinus (SSS). For some patients, the LH had some features resembling the pattern of migraine without aura.Case descriptionA 45 year-old woman complained with a distinct headache for more than half years. The pain trajectory of the headache is confined to a coronal line-shaped area of 5–10 mm in width linking the two points in the bilateral temporal regions with the occipital protuberance. This coronal line-shaped pain area is close and parallel to a coronal cambered venous sinus complex, the combination of the confluences of sinus and the bilateral cavernous sinus (CS), superior petrosal sinus (SPS) linking the CS with transverse sinus (TS) and TS into which the SPS feeds. The patient had a past history of migraine without aura for 10 years and her son had a benign paroxysmal vertigo (BPV) for 12 years. Both of her coronal line-shaped headache and her son’s vertigo had well response to sodium valproate.Discussion and evaluationIts clinical characteristics were distinctly different from those of other two headache entities defined with topographical criteria, nummular headache and epicrania fugax, and different from other existing headache entities except for migraine without aura.ConclusionThe distinct coronal line-shaped headache is suggestive of a variant of LH, a coronal LH, and probably belongs to a subtype of migraine without aura as proposed for LH. This coronal LH reinforces the proposal of LH as a new headache syndrome or a subtype of a previously known headache syndrome, probably of migraine.

Linear headache: clinical characteristics of eight new cases

“…This proposed pathogenesis is further supported by our recent case study of a woman who had a recurrent head pain circumscribed in a coronal line-shaped area around the head, a coronal LH. Similar to the LH pain area close and parallel to the sagittal venous sinus, SSS, this coronal LH pain area is close and parallel to a coronal cambered venous sinus complex, the combination of the confluens of sinus (CFS) and the bilateral cavernous sinus (CS), superior petrosal sinus (SPS) linking the CS with transverse sinus (TS) and TS into which the SPS feeds (Wang et al 2016 ), Whereas, this proposed pathogenesis underlying LH is pure speculation, further observations of its clinical characteristics and pathophysiological studies are required to clarify it. For example, studies of the cerebral excitability in LH in comparision with that in migraine without aura in human and studies of venous sinus endophlebitis-induced activation of neurons in the spinal nociceptive center, the trigeminocervical complex, in animal model may be helpful to clarify the pathogenesis of LH.…”

Epicranial headaches part 2: Nummular headache and epicrania fugax

“…To date, 37 cases of LH have been reported in the literature (67)(68)(69)(70), with a mean age of onset in the fourth decade of life, and with a female predominance. As in NH, a significant proportion of patients with LH exhibit symptoms and/or signs of sensory dysfunction within the painful territory.…”