Neurology Department, Hospital Clínico Universitario, Valladolid, Spain.
Headache. 2010 Mar;50(3):451-8. doi: 10.1111/j.1526-4610.2009.01607.x. Epub 2010 Jan 20.
We aimed to report 10 new cases of epicrania fugax (EF), showing their clinical features and therapeutic responses.
Epicrania fugax has been recently described as a paroxysmal head pain starting in a focal area located at a posterior cranial region and rapidly spreading forward to the ipsilateral eye or nose along a linear or zigzag trajectory. In some patients the pain is followed by ocular or nasal autonomic features. In the prior series, 1 patient got pain relief with anesthetic blockades, while another patient improved with carbamazepine.
Since the first description of EF, we have assessed 10 patients with the same clinical picture (8 women and 2 men) at the Neurology outpatient offices of our 2 centers.
The mean age at onset was 48.5 years (SD: 19.8, range: 23-83). All the patients complained of strictly unilateral pain paroxysms starting at parietal (n = 5), occipital (n = 4), or parieto-occipital locations (n = 1), and immediately spreading forward through a linear pathway toward the ipsilateral forehead (n = 3) or the ipsilateral eye (n = 7), the complete sequence lasting 1-10 seconds. No trigger was identified in any of our patients, while 5 of them suffered mild pain in the stemming area between the paroxysms. Three patients had ipsilateral lacrimation, and 2 had conjunctival injection at the end of the attacks. The frequency ranged from 1 attack per week to multiple attacks per day. Neuroimaging and laboratory tests were consistently normal. Interictal pain was responsive to acetaminophen. In 3 cases a preventive was considered in order to avoid the paroxysms. Gabapentin led to significant improvement in 2 cases. The third patient did not obtain any benefit from gabapentin or amitriptyline, but improved slightly with lamotrigine.
This description reinforces the proposal of EF as a new headache variant or a new headache syndrome. Anesthetic blockades, carbamazepine, gabapentin, and lamotrigine have been apparently effective in individual patients. Further observations and therapeutic trials are needed.
报告 10 例新发颅外痛（EF）病例，描述其临床特征和治疗反应。
颅外痛最近被描述为一种阵发性头痛，起始于颅后区域的局灶性部位，并迅速沿线性或锯齿状轨迹向前扩散至同侧眼或鼻，同时伴有眼部或鼻部自主神经症状。在前一系列研究中，1 例患者经麻醉阻滞治疗后疼痛缓解，另 1 例患者使用卡马西平治疗后病情改善。
自 EF 首次描述以来，我们在 2 个中心的神经内科门诊评估了 10 例具有相同临床表现的患者（8 例女性，2 例男性）。
发病年龄的平均值为 48.5 岁（标准差：19.8，范围：23-83）。所有患者均主诉单侧严格的阵发性疼痛，起始于顶骨（n=5）、枕骨（n=4）或顶枕骨（n=1），并立即沿线性通路向前扩散至同侧额部（n=3）或同侧眼（n=7），整个发作过程持续 1-10 秒。我们的患者均未发现触发因素，5 例患者在发作间期的起始部位有轻度疼痛。3 例患者出现同侧流泪，2 例患者在发作结束时出现结膜充血。发作频率从每周 1 次到每天多次不等。神经影像学和实验室检查均正常。发作间期疼痛对乙酰氨基酚有效。为避免发作，3 例患者考虑进行预防性治疗。加巴喷丁治疗使 2 例患者病情显著改善。第 3 例患者使用加巴喷丁和阿米替林均无效，但使用拉莫三嗪后略有改善。
该描述进一步支持将 EF 作为一种新的头痛变异或新的头痛综合征。麻醉阻滞、卡马西平、加巴喷丁和拉莫三嗪对个别患者有效。需要进一步观察和治疗试验。
