The temporal evolution of a facial pain syndrome associated with neurovascular contact: a case report
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The temporal evolution of a facial pain syndrome associated with neurovascular contact : a case report. / Khan, Sabrina; Wibrandt, Ida; Rochat, Per Bjørnstad; Ashina, Messoud.
In: Journal of Headache and Pain, Vol. 16, No. 12, 12, 2015, p. 1-5.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - The temporal evolution of a facial pain syndrome associated with neurovascular contact
T2 - a case report
AU - Khan, Sabrina
AU - Wibrandt, Ida
AU - Rochat, Per Bjørnstad
AU - Ashina, Messoud
PY - 2015
Y1 - 2015
N2 - BACKGROUND: Trigeminal autonomic cephalalgias are primary headaches characterized by unilateral pain and cranial autonomic symptoms. However, associated autonomic symptoms have also been reported in other headaches and facial pains, e.g. trigeminal neuralgia, with the clinical differentiation proving a complex task.CASE: A 54-year-old man presented with right-sided, sharp, intense facial pain in the distribution area of the trigeminal nerve. Pain duration was from seconds to a few minutes, and trigger factors included ipsilateral touching of the skin and hair. Over the next ten years, symptoms progressed and changed presentation, also displaying as right-sided, severe, orbital pain, lasting 60 to 90 minutes, with conjunctival injection and rhinorrhea. Neurological examination was normal. Numerous medications were tried with limited or no effect. In 2010, magnetic resonance imaging revealed a right-sided deviation of the basilar artery at the level of pons, creating neurovascular contact with the trigeminal nerve. Microvascular decompression was performed, and symptoms resolved within days.CONCLUSION: Differentiating between trigeminal autonomic cephalalgias and trigeminal neuralgia with autonomic symptoms can be challenging. The distinct change and evolution over time in the clinical presentation of the patient's head pain suggests a temporal plasticity of the pain in head and facial syndromes, irrespective of underlying pathoanatomic features.
AB - BACKGROUND: Trigeminal autonomic cephalalgias are primary headaches characterized by unilateral pain and cranial autonomic symptoms. However, associated autonomic symptoms have also been reported in other headaches and facial pains, e.g. trigeminal neuralgia, with the clinical differentiation proving a complex task.CASE: A 54-year-old man presented with right-sided, sharp, intense facial pain in the distribution area of the trigeminal nerve. Pain duration was from seconds to a few minutes, and trigger factors included ipsilateral touching of the skin and hair. Over the next ten years, symptoms progressed and changed presentation, also displaying as right-sided, severe, orbital pain, lasting 60 to 90 minutes, with conjunctival injection and rhinorrhea. Neurological examination was normal. Numerous medications were tried with limited or no effect. In 2010, magnetic resonance imaging revealed a right-sided deviation of the basilar artery at the level of pons, creating neurovascular contact with the trigeminal nerve. Microvascular decompression was performed, and symptoms resolved within days.CONCLUSION: Differentiating between trigeminal autonomic cephalalgias and trigeminal neuralgia with autonomic symptoms can be challenging. The distinct change and evolution over time in the clinical presentation of the patient's head pain suggests a temporal plasticity of the pain in head and facial syndromes, irrespective of underlying pathoanatomic features.
KW - Diagnosis, Differential
KW - Facial Neuralgia
KW - Facial Pain
KW - Humans
KW - Magnetic Resonance Imaging
KW - Male
KW - Middle Aged
KW - Trigeminal Autonomic Cephalalgias
KW - Trigeminal Nerve
KW - Trigeminal Neuralgia
U2 - 10.1186/s10194-015-0497-5
DO - 10.1186/s10194-015-0497-5
M3 - Journal article
C2 - 25904283
VL - 16
SP - 1
EP - 5
JO - Journal of Headache and Pain
JF - Journal of Headache and Pain
SN - 1129-2369
IS - 12
M1 - 12
ER -
ID: 159107206