Clinical features and long-term prognosis of trochlear headaches.

Abstract

BACKGROUND AND PURPOSE:

Trochlear headaches are a recently recognized cause of headache, of which both primary and inflammatory subtypes are recognized. The clinical features, long-term prognosis and optimal treatment strategy have not been well defined.

METHODS:

A cohort of 25 patients with trochlear headache seen at the Mayo Clinic between 10 July 2007 and 28 June 2012 were identified.

RESULTS:

The diagnosis of trochlear headache was not recognized by the referring neurologist or ophthalmologist in any case. Patients most often presented with a new daily from onset headache (n = 22, 88%). The most characteristic headache syndrome was reported as continuous, achy, periorbital pain associated with photophobia and aggravation by eye movement, especially reading. Individuals with a prior history of migraine were likely to have associated nausea and experience trochlear migraine. Amongst individuals with trochleitis, 5/12 (41.6%) had an identified secondary mechanism. Treatment responses were generally, but not invariably, favorable to dexamethasone/lidocaine injections near the trochlea. At a median follow-up of 34 months (range 0-68), 10/25 (40%) of the cohort had experienced complete remission.

CONCLUSIONS:

Trochlear headaches are poorly recognized, have characteristic clinical features, and often require serial injections to optimize the treatment outcome. The identification of trochleitis should prompt neuroimaging to look for a secondary cause.

• Authors: J H Smith, J A Garrity, C J Boes
• Journal: European journal of neurology (Eur J Neurol) Vol. 21 Issue 4 Pg. 577-85 (Apr 2014) ISSN: 1468-1331 [Electronic] England
• PMID: 24261483 (Publication Type: Journal Article)
• Copyright: © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.

Chemical References

• Anti-Inflammatory Agents
• Neuromuscular Agents
• Botulinum Toxins, Type A

Topics

• Adolescent
• Adult
• Aged
• Anti-Inflammatory Agents (therapeutic use)
• Botulinum Toxins, Type A (therapeutic use)
• Calcinosis (complications)
• Cohort Studies
• Disease Progression
• Female
• Headache (diagnosis, drug therapy, pathology, physiopathology)
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neuromuscular Agents (therapeutic use)
• Orbit (physiopathology)
• Tomography Scanners, X-Ray Computed
• Young Adult