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Headache associated with vascular disease: migraine and stroke
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
The term carotidynia was first used by Fay158 to refer to tenderness of the bifurcation of the carotid artery in some patients with ‘atypical facial neuralgia’. Carotidynia now refers to a syndrome characterized by unilateral neck pain and carotid arteiy tenderness.159 However, the unilateral neck pain has no specific clinical characteristics or temporal pattern and local tenderness, swelling and increased pulsations are neither constant nor specific. Carotidynia is not a unique entity but rather a symptom (unilateral neck pain with local tenderness) of many vascular and nonvas-cular conditions. Recurring attacks of carotidynia with headache that last a few days are probably related to migraine; attacks that last a few minutes suggest chronic paroxysmal hemicrania; and regular daily attacks of 1 or 2 hours’ duration suggest cluster headache. Acute selflimited carotidynia may be viral in origin, but carotid dissection must be excluded. Causes of chronic carotidy-nia include carotid artery diseases (occlusion, fibromuscular dysplasia, giant cell arteritis, or carotid endarterectomy), carotid-body tumors, lymphadenitis, pharyngitis, dental infection, local aphthous ulcers, and malignant infiltration.25,106,159,160
Orofacial Pain Syndromes and Other Facial Neuralgias
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
Carotidynia is an episodic, throbbing, deep, dull neck pain with occasional neck swelling. The pain over the neck may project to the ipsilateral side of the head. It is self-limiting, usually less than two weeks. Carotidynia is thought by many to be nothing more than a unilateral neck pain associated with local tenderness that can be secondary to a number of vascular and nonvascular etiologies (including fibromuscular dysplasia, giant cell arteritis, lymphadenitis, local aphthous ulcers, and malignant infiltration) (17-23).
Myocarditis and carotidynia caused by Granulocyte-Colony stimulating factor administration
Published in Modern Rheumatology Case Reports, 2020
Elena Corral de la Fuente, Arantza Barquín Garcia, Cristina Saavedra Serrano, Juan José Serrano Domingo, Roberto Martín Huertas, María Fernández Abad, Noelia Martínez Jáñez
On the other hand, carotidynia is a very rare and mostly idiopathic disease. It is characterised by an inflammation which is limited to the distal common carotid artery that arises directly from the aorta on the left and as a branch of the brachiocephalic trunk on the right [12,17]. The International Headache Society (IHS) defined the diagnostic criteria for idiopathic carotidynia. Although this term was removed from the revised classification of the IHS in 2004, certain authors accept carotidynia as an idiopathic inflammatory process without defined pathophysiological substrate, leading to a characteristic clinical condition without structural vascular lesion or identifiable underlying cause (diagnosis of exclusion) [18,19].
Persistent shoulder pain as a first manifestation of vasculo-Behçet
Published in Scandinavian Journal of Rheumatology, 2023
M Seabra Rato, R Miriam Ferreira, L Costa
Six months later, she persistently complained about exercise-induced right shoulder pain and fatigue, mostly when performing some activities that demanded upper limb elevation, suggesting intermittent claudication. She also reported intense and continuous left cervical pain and transient episodes of dizziness. On the follow-up, inflammatory parameters decreased but remained discrepantly very high. A new examination of the shoulders did not reveal localized tenderness, differences in temperature and colour, or limitations in the range of motion. However, brachial and radial pulses were decreased on the right side. No other changes were found that could suggest ischaemia. Cardiopulmonary auscultation was normal, with no audible bruits in the vascular territory. Measurement of four-limb blood pressure was normal and symmetrical. On palpation, tenderness of the carotid artery was observed, confirming carotidynia. Neurological examination was unremarkable. A magnetic resonance angiography was performed and showed a concentric vessel wall thickening with lumen narrowing of the aortic arch, brachiocephalic arterial trunk, right and left common carotid arteries, right and left subclavian arteries, and right axillary artery, compatible with vasculitis (Figure 1). No aneurysms or pseudoaneurysms were evident and there were no relevant alterations in ascending and descending thoracic and abdominal aorta. The transthoracic echocardiogram had no changes. Based on these findings, the diagnosis of vasculo-Behçet was established. The patient was treated with a high-dose glucocorticoid (prednisolone 1 mg/kg/day, gradually tapered to 10 mg/day) and monthly intravenous cyclophosphamide (750 mg) for 6 months, with complete symptom relief and decrease in serum inflammatory markers. Subcutaneous methotrexate (15 mg/week) was chosen for maintenance treatment. At the last visit, over a 12 month follow-up period, the patient revealed a sustained clinical response.