Clinical features and long‐term prognosis of trochlear headaches. (22nd November 2013)

• Record Type: Journal Article
• Authors: Smith, J. H.; Garrity, J. A.; Boes, C. J.
• Is Part Of: European journal of neurology. Volume 21:Number 4(2014:Apr.)
• Page Start: 577
• Page End: 585
• Publication Date: 2013-11-22
• Subjects: Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.12312
• Languages: English
• ISSNs: 1351-5101

Abstract

<abstract abstract-type="main" id="ene12312-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ene12312-sec-0001" sec-type="section"> <title>Background and purpose</title> <p>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.</p> </sec> <sec id="ene12312-sec-0002" sec-type="section"> <title>Methods</title> <p>A cohort of 25 patients with trochlear headache seen at the Mayo Clinic between 10 July 2007 and 28 June 2012 were identified.</p> </sec> <sec id="ene12312-sec-0003" sec-type="section"> <title>Results</title> <p>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 (<italic>n</italic> = 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.</p> </sec> <sec id="ene12312-sec-0004" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>