title: Widespread headache as the first clinical manifestation of giant cell arteritis in patients affected by polymyalgia rheumatica.
abstract: BACKGROUND
  In giant cell arteritis (GCA) headache of new onset due to inflammatory involvement of the temporal artery (TA) represents a diagnostic criterion. A widespread headache (WH) with scalp tenderness due to cranial arteritis can represent another manifestation of GCA.
  
  
  METHODS
  In 225 elderly patients with polymyalgia rheumatica (PMR) followed in our rheumatologic outpatient clinic from 2004 until June 2016, the frequency of WH as the first clinical manifestation of GCA was evaluated.
  
  
  RESULTS
  Among 26 patients with GCA+PMR (11.6% of total), 5 (23.07%) had WH as first clinical manifestation of GCA without TA. In all these patients TA colour duplex sonography (CDS) and 18-fluorodeoxyglucose positron emission tomography (FDG-PET) with total body contrast-enhanced CT was consistent with the diagnosis of arteritis. TA biopsy was not performed. High doses of prednisone (1 mg/kg/day) led to the immediate and total disappearance of the headache.
  
  
  CONCLUSIONS
  The widespread headache should be considered as the first symptom GCA and in cases of suspicion of vasculitis patients should have a full diagnostics examination. Colour duplex sonography and FDG-PET with total body contrast-enhanced CT are useful tools for non-invasive diagnosis of GCA.
authors.affiliation: Internal and Geriatric Department ASL NA 3 sud, Rheumatologic Outpatient Clinic hospital "Mariano Lauro", Sant'Agnello, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Manzo
keywords: giant cell arteritis; polymyalgia rheumatica; tension headache; widespread headache