title: The temporal evolution of a facial pain syndrome associated with neurovascular contact: a case report.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Danish Headache Center, Department of Neurology, Glostrup Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, DK-2600, Denmark. sksabrinakhan@gmail.com.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Khan
authors.affiliation: Danish Headache Center, Department of Neurology, Glostrup Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, DK-2600, Denmark. ida.wibrandt@gmail.com.
authors.forename: Ida
authors.initials: I
authors.lastname: Wibrandt
authors.affiliation: Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Denmark. per.bjoernstad.rochat@regionh.dk.
authors.forename: Per
authors.initials: P
authors.lastname: Rochat
authors.affiliation: Danish Headache Center, Department of Neurology, Glostrup Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, DK-2600, Denmark. ashina@dadlnet.dk.
authors.forename: Messoud
authors.initials: M
authors.lastname: Ashina
mesh_terms: D003937:Diagnosis, Differential; D005156:Facial Neuralgia / Q000150:complications / Q000175:diagnosis*; D005157:Facial Pain / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D051303:Trigeminal Autonomic Cephalalgias / Q000150:complications / Q000175:diagnosis*; D014276:Trigeminal Nerve / Q000601:surgery; D014277:Trigeminal Neuralgia / Q000150:complications / Q000175:diagnosis*