Primary trochlear headache

Abstract

The trochlear region is the origin of a specific and unrecognized headache, which we have named primary trochlear headache. Local treatment on the trochlear area is also useful for other concurrent primary headaches with inadequate response to oral therapy.

Diagnosis and Management of Trochleodynia, Trochleitis, and Trochlear Headache

“…Diagnosis and early treatment could lead to better outcomes and reduced level of disability in patients suffering from poorly controlled MH or TTH. Meanwhile, trochlear pain treatment is commonly overlooked, since most patients often have coexisting headache disorders (5, 6).…”

“…Here, we categorize trochleodynia as a spectrum of disorders characterized by pain arising from the trochlear region and one or more of the following structures: the cartilaginous trochlea, the superior oblique (SO) muscle, the SO tendon and fibrovascular sheath, and the surrounding nerves that provide nociceptive input, mainly the supraorbital and supratrochlear nerves (Figure 1) (5). The literature on this entity is scarce, but recently, it has become recognized as a distinct disorder by the International Headache Society (7) and case series have arisen from Italy (8), Spain (9), Thailand (10), and United States (6).…”

“…There are three probable etiologies of the pain experienced in trochleodynia: (1) neuropathic, (2) neuromuscular, and (3) inflammatory. The neuropathic pain hypothesis was first proposed by Yanguela et al in a case series of 18 patients (5). A cycle of repeated trauma to the supraorbital and supratrochlear nerve running proximal to the trochlea leads to nociception perceived in the periorbital or frontal hemicranial distribution.…”

Pediatric trochleitis associated with paranasal sinusitis: a case report

“…Trochlear pain is subclassified into primary trochlear headache, trochlear migraine, trochleitis, and inflammatory Brown syndrome [1]. Primary trochlear headache is a specific headache localized in the trochlear region without evidence of inflammation [3]. Trochlear migraine is diagnosed when exacerbation of the trochlear pain triggers a migraine attack [1].…”

“…Secondary trochleitis associated with rheumatologic and immunologic disorders, including systemic lupus erythematous and rheumatoid arthritis, can develop [1, 7]. Because the majority of cases involve non-infectious inflammation, oral non-steroidal anti-inflammatory drugs (NSAIDs), systemic corticosteroids, and local steroid injections show favorable outcomes [3–5]. To the best of our knowledge, trochleitis associated with paranasal sinusitis, however, has not been reported, despite the anatomical proximity between the paranasal sinus and trochlear nerve.…”