Epicrania fugax with backward radiation: clinical characteristics of nine new cases

Abstract

Epicrania fugax (EF) is a novel syndrome, described as a paroxysmal and brief head pain, starting in posterior cranial regions and rapidly spreading forward ipsilateral eye, nose or forehead. Two patients with comparable clinical features stemming from frontal scalp to ipsilateral posterior regions have been recently described and proposed as backward radiation epicrania fugax (BREF). We report a new series of nine BREF and compare their clinical characteristics with 18 forward radiation EF (FREF). Since first description of BREF in February 2010 we have assessed nine patients (four males, five females) with this clinical picture at an outpatient headache office in a Tertiary Hospital. Comparison is established with 18 FREF patients (6 males, 12 females), attended since the publication of first series of EF in March 2008. We found no differences between BREF and FREF, respectively, in age at onset (43.4 ± 13.1 vs. 42.5 ± 17.7 years), female/male ratio (5/4 vs. 12/6), pain intensity (6.9 ± 2.1 vs. 6.8 ± 2.1 in a 0–10 visual analogical scale), duration (7.1 ± 4.9 vs. 5.7 ± 4.3 s) and frequency of episodes per day (7 ± 8.4 vs. 9.9 ± 15.4). Patients in BREF group presented less frequently interictal pain in stemming point (22.2 vs. 55.5%) and accompanying autonomic signs (33.3 vs. 55.5%), but without statistical significance in both the cases. This series reinforces the proposal of EF as a new headache variant or a new headache syndrome. Clinical picture of brief pain paroxysms starting in the anterior scalp and radiating backwards does not fit known headaches or neuralgias and might correspond to a reverse variant of EF, clinical characteristics of which are comparable to FREF.

Nummular Headache and Epicrania Fugax: Possible Association of Epicranias in Eight Patients: Table 1

“…Mean age at onset was 44.2 ± 12 years (range: 23–60). Patients 1, 2, 5, 7, and 8 have already been described in other publications . No underlying lesion or prior trauma was documented in any of them.…”

Facial Pain Radiating Upwards: Could the Pain of Epicrania Fugax Start in the Lower Face?

“…Epicrania fugax (EF) has been recently classified as a primary headache in the appendix of the International Classification of Headache Disorders, 3rd edition, beta version . Since EF was first proposed as a new syndrome by Pareja et al in 2008, more than 60 cases have been reported . The essential feature of EF is the occurrence of dynamic painful paroxysms, with a quick and ample movement through the surface of one side of the head.…”

Epicrania Fugax: 19 Cases of an Emerging Headache

“…According to the original description, EF is characterized by brief pain paroxysms starting in a particular area of the posterior scalp, and rapidly radiating forwards along a lineal or zigzag trajectory to reach the ipsilateral forehead, eye, or nose in one to a few seconds (Figure ). A new variant of EF has also been acknowledged, in which the irradiation of the pain follows an opposite, backward direction . In some patients, the painful paroxysms are accompanied by ocular or nasal autonomic signs, such as conjunctival injection, lacrimation, or rhinorrhea.…”