Pain Paroxysms With Coronal Radiation: Case Series and Proposal of a New Variant of Epicrania Fugax.
OBJECTIVE
We aim to report 4 patients with brief pain paroxysms whose clinical features remind of typical epicrania fugax (EF), except for the direction along a transverse trajectory.


BACKGROUND
EF has been defined as a brief paroxysmal head pain, with stabbing quality, describing a linear or zig-zag trajectory across the surface of one hemicranium.


METHODS
We considered all patients attending the headache outpatient office at 3 tertiary hospitals from March 2008 to December 2015. We identified a total of 4 cases with dynamic pain paroxysms moving in coronal direction.


RESULTS
The mean age at onset was 49 years (range 34-75). All the patients suffered a dynamic pain from parietal or temporal areas to the contralateral ones, crossing the midline in a linear or zig zag trajectory, the entire sequence lasting 2-3 seconds. No triggers were identified. One patient noticed mild interictal tenderness at the stemming point. The frequency of the attacks varied from 2 per week to 1 every 2 months. No underlying disorders were identified by physical and neurological exams and neuroimaging and laboratory tests.


CONCLUSIONS
Our patients presented with a paroxysmal head pain that might correspond to a transverse variant of EF. These observations may not only expand the EF phenotype but also reinforce the distinction between EF and pericranial neuralgias.
From the Department of Neurology, Hospital Universitario Quirón Madrid, Pozuelo de Alarcón, Madrid, Spain.
Javier
J
Casas-Limón
Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.
María L
ML
Cuadrado
Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Marina
M
Ruiz
Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Elena
E
Martínez
Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.
Álvaro
Á
Gutiérrez-Viedma
Department of Neurology, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain.
Carlos M
CM
Ordás
Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Ángel L
ÁL
Guerrero
D000328:Adult; D000368:Aged; D005260:Female; D006261:Headache / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000150:complications*; D017288:Pain Threshold / Q000502:physiology*; D010812:Physical Stimulation; D012189:Retrospective Studies; D012535:Scalp / Q000503:physiopathology*; D062606:Tertiary Care Centers; D064232:Visual Analog Scale
epicrania; epicrania fugax; pericranial neuralgias