Yangüela J, Sánchez-del-Rio M, Bueno A, Espinosa A, Gili P, Lopez-Ferrando N, Barriga F, Nieto J C, Pareja J A
Ophthalmology Unit, Fundación Hospital Alcorcón, Madrid, Spain.
Neurology. 2004 Apr 13;62(7):1134-40. doi: 10.1212/01.wnl.0000118841.97273.5d.
The authors have observed a group of patients complaining of periorbital pain, emanating from the trochlear area, in absence of trochleitis or other orbital or systemic disease. All were previously diagnosed and treated as different types of headaches, but pain was not controlled until local treatment on the sore trochlea was performed. The authors have investigated the role of the trochlear area in causing and modulating headache.
Observational case series. Trochlear pain was defined as pain on this area, exacerbated upon examination and looking in supraduction. Pain was studied after trochlear injections of lidocaine, corticosteroids, and placebo. Secondary orbital pain was ruled out.
Seventeen women and one man were evaluated (mean age: 44 years). All presented unilateral pain in the trochlear area (60% reported more extended headache), for more than 1 year in 70%. Neither ocular autonomic signs nor motility restrictions were observed. Imaging examinations were normal in 100%. The temporal pattern was either chronic or remitting, with acute exacerbations. Pain increased at night in 55%. A total of 62% presented concurrent headaches. Locally injected corticosteroids relieved the pain within 48 hours in 95% and also improved concurrent headaches, by decreasing attack frequency and analgesics intake. Placebo was not helpful. Relapses were observed in 45% (average 8 months).
The trochlear region is the origin of a specific and unrecognized headache, which we have named primary trochlear headache. Local treatment on the trochlear area is also useful for other concurrent primary headaches with inadequate response to oral therapy.
作者观察到一组患者，他们诉说眶周疼痛，疼痛源自滑车区，且不存在滑车炎或其他眼眶或全身性疾病。所有患者之前均被诊断为不同类型的头痛并接受了相应治疗，但在对疼痛的滑车区进行局部治疗之前，疼痛一直未得到控制。作者研究了滑车区在引发和调节头痛中的作用。
观察性病例系列研究。滑车区疼痛定义为该区域的疼痛，在检查及向上注视时会加重。在滑车区注射利多卡因、皮质类固醇和安慰剂后对疼痛进行研究。排除继发性眼眶疼痛。
共评估了17名女性和1名男性（平均年龄：44岁）。所有患者均表现为滑车区单侧疼痛（60%报告头痛范围更广），70%的患者疼痛持续超过1年。未观察到眼部自主神经体征或眼球运动受限。100%的影像学检查结果正常。疼痛的时间模式为慢性或缓解性，伴有急性加重。55%的患者夜间疼痛加剧。共有62%的患者同时伴有头痛。局部注射皮质类固醇后，95%的患者在48小时内疼痛缓解，同时头痛也有所改善，发作频率降低，镇痛药用量减少。安慰剂无效。45%的患者出现复发（平均8个月）。
滑车区是一种特定的、未被认识的头痛的起源，我们将其命名为原发性滑车头痛。滑车区的局部治疗对其他对口服治疗反应不佳的同时存在的原发性头痛也有效。
