Cranial and Facial Epicrania Fugax: Combination of Both Clinical Pictures in the Same Patients

Gómez‐Mayordomo, Víctor; García-Sáez, Rafael; Gallego-Gallego, María; González‐García, Nuria; Cuadrado, María‐Luz

doi:10.1111/head.13755

Cited by 4 publications

(6 citation statements)

References 8 publications

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“…These patients presented with paroxysms of pain that crossed several dermatomes of the face, either upwards or downwards (Figure 7), with or without extension into the cranial region (120,121). Moreover, two additional cases have been reported that combined episodes of facial and cranial EF (122); this finding supports the idea that both types of EF are just two distinct clinical presentations of the same disease.…”

Section: Epicrania Fugaxsupporting

confidence: 64%

“…The drugs most used in EF are antiseizure medications; satisfactory therapeutic responses have been reported for several drugs in this group, especially gabapentin (30,(71)(72)(73)(74)109,116,(120)(121)(122)124) and lamotrigine (71)(72)(73)(74)(75)116,120,121,124) but also pregabalin (74,121), carbamazepine (73,103,117,121), oxcarbazepine (120,121), eslicarbazepine (107,121,125), lacosamide (121), and levetiracetam (74). Amitriptyline (73,75,116,122), duloxetine (120), and indomethacin (74,75) have also been used with effect in a minority of patients. If the response to initial treatment is unsatisfactory, another treatment may be tried, as patients who do not respond to the first option may find relief with subsequent options.…”

Section: Treatmentmentioning

confidence: 99%

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Epicranial headaches part 2: Nummular headache and epicrania fugax

Cuadrado

2023

Cephalalgia

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Background Nummular headache and epicrania fugax are two primary headaches that fall under the heading of epicranial headaches. Methods This article reviews the epidemiological and clinical features of nummular headache and epicrania fugax, proposed pathogenic mechanisms and state-of-the-art management, according to the literature. Results and conclusions Nummular headache and epicrania fugax are generally viewed as rare headache disorders, but no population-based epidemiological data are available. Nummular headache is characterized by continuous or intermittent head pain, which remains circumscribed in a round or oval area of the scalp, typically one to six centimeters in diameter. Epicrania fugax manifests with brief paroxysms of pain that move along the surface of the head, following a linear or zigzag trajectory through different nerve territories. Nummular headache and epicrania fugax are mostly primary headaches, but some secondary cases have been reported. The pathogenesis of these headaches is not fully understood. Nummular headache could probably originate in epicranial tissues or adjacent intracranial structures, while the origin of epicrania fugax could be extracranial or intracranial. Diagnostic assessment requires careful examination of the symptomatic areas. Underlying disorders should be excluded by additional investigations, including neuroimaging and appropriate blood tests. No controlled clinical trials have been conducted in nummular headache or epicrania fugax. Analgesics and anti-inflammatory drugs, botulinum toxin and gabapentin are currently the most recommended treatment options for nummular headache. In epicrania fugax, the most used treatments are gabapentin, lamotrigine, and other antiseizure medications.

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Section: Epicrania Fugaxsupporting

confidence: 64%

Section: Treatmentmentioning

confidence: 99%

Epicranial headaches part 2: Nummular headache and epicrania fugax

Cuadrado

2023

Cephalalgia

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“…Among these atypical cases, one had a sagittal trajectory (7), four had coronal trajectories (8), and one had paroxysms running in multiple directions (9). A facial variant of EF has also been described in 15 patients, with the pain crossing several dermatomes of the face in an upward or downward direction (10)(11)(12)). Yet, until very recently, all the described cases were circumscribed to trigeminal or occipital nerve territories.…”

Section: Introductionmentioning

confidence: 99%

Paroxysmal headache with extracephalic irradiation: Proposal for a new variant of epicrania fugax in a series of five patients

et al. 2020

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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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“…6 The hypothesis of a possible central generator would be further reinforced by the existence of EF cases in which pain can originate at different points and travel along different trajectories. [8][9][10][11][12] EF is probably not a purely "peripheral" or purely "central" disorder. The genesis of pain could rely on peripheral generators (epicranial or intracranial) or, alternatively, on CNS generators.…”

mentioning

confidence: 99%