title: Clinical characteristics of headache or facial pain prior to the development of acute herpes zoster of the head.
abstract: OBJECTIVE
  When physicians encounter patients with headache or facial pain (preeruptive pain) associated with acute herpes zoster of the head, especially before the appearance of characteristic skin eruptions (preeruptive phase), they typically find it difficult to make clinical impressions and apply appropriate diagnostic or therapeutic procedures. The objectives of this study were to describe the clinical characteristics of headache or facial pain associated with acute herpes zoster of the head and to elucidate the association between the manifestation of these symptoms in the preeruptive phase and incoming herpes zoster.
  
  
  METHODS
  We retrospectively analyzed the clinical features of 152 patients with acute herpes zoster involving only the head who presented within 10days of rash onset at Chungbuk National University Hospital, a tertiary hospital in Chungcheongbuk-do in South Korea, between January 2011 and December 2015.
  
  
  RESULTS
  The mean age of the patients was 54.3±19.8years. One hundred patients had herpes zoster in the trigeminal nerve, 34 in the nervus intermedius, and 18 in the upper cervical nerves. Preeruptive pain was present in 112 (73.7%) patients and had a mean duration of 3.0±1.3days (range, 1-6days). Severity of pain was associated with the presence of preeruptive pain (p=0.040). Headache or facial pain was limited to the ipsilateral side of the face and head in all patients, except for two who had with severe symptoms of meningitis, and was of moderate to severe intensity (90.1%). Pain of a stabbing nature was observed in 128 (84.2%) patients, and 146 (96.1%) reported experiencing this type of pain for the first time. Pain awakened 94 (61.8%) patients from sleep. Sixty-one (54.5%) of the 112 patients with preeruptive pain visited a hospital during the preeruptive phase; their preeruptive phase was significantly longer (p<0.001) and more frequently awakened them from sleep (p=0.008). Their presumptive diagnoses were as follows: tension-type headache (n=20, 32.8%); no decision (n=18, 29.5%); herpes zoster (n=5, 8.2%); migraine (n=3, 4.9%); pain associated with upper respiratory tract infection (n=3, 4.9%); parotitis (n=2, 3.3%); dry eye (n=2, 3.3%); and other (n=1 each: trigeminal neuralgia, glaucoma, pharyngitis, vestibular neuronitis, tonsillitis, teeth problems, otitis media, and occipital neuralgia).
  
  
  CONCLUSIONS
  These results suggest that the typical pain of acute herpes zoster of the head has a stabbing quality, is felt unilaterally, is moderate to severe, often awakens patients from sleep, and has not been previously experienced by most patients. When encountering patients with these features accompanied by pain onset of less than one week, acute herpes zoster of the head should be considered, even without characteristic vesicles, after excluding other secondary causes by appropriate diagnostic workup.
authors.affiliation: Department of Neurology, College of Medicine, Chungbuk National University, Republic of Korea.
authors.forename: Hye Lim
authors.initials: HL
authors.lastname: Lee
authors.affiliation: Department of Neurology, College of Medicine, Chungbuk National University, Republic of Korea.
authors.forename: Minju
authors.initials: M
authors.lastname: Yeo
authors.affiliation: Department of Dermatology, College of Medicine, Chungbuk National University, Republic of Korea.
authors.forename: Gi Hwa
authors.initials: GH
authors.lastname: Choi
authors.affiliation: Department of Dermatology, College of Medicine, Chungbuk National University, Republic of Korea.
authors.forename: Ji Yeoun
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Neurology, College of Medicine, Chungbuk National University, Republic of Korea.
authors.forename: Ji Seon
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Neurology, College of Medicine, Chungbuk National University, Republic of Korea.
authors.forename: Dong-Ick
authors.initials: DI
authors.lastname: Shin
authors.affiliation: Department of Neurology, College of Medicine, Chungbuk National University, Republic of Korea.
authors.forename: Sang-Soo
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Department of Neurology, College of Medicine, Chungbuk National University, Republic of Korea. Electronic address: sunghlee@chungbuk.ac.kr.
authors.forename: Sung-Hyun
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005157:Facial Pain / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006257:Head; D006261:Headache / Q000175:diagnosis* / Q000209:etiology; D051271:Headache Disorders, Secondary / Q000175:diagnosis* / Q000209:etiology; D006562:Herpes Zoster / Q000150:complications / Q000175:diagnosis*; D006563:Herpes Zoster Ophthalmicus / Q000150:complications / Q000175:diagnosis; D016697:Herpes Zoster Oticus / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: Headache; Herpes zoster; Herpes zoster ophthalmicus; Herpes zoster oticus; Preeruptive herpes zoster; Primary stabbing headache; Secondary headache