Khan Sabrina, Wibrandt Ida, Rochat Per, Ashina Messoud
Danish Headache Center, Department of Neurology, Glostrup Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, DK-2600, Denmark.
Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Denmark.
J Headache Pain. 2015 Feb 11;16:12. doi: 10.1186/s10194-015-0497-5.
Trigeminal autonomic cephalalgias are primary headaches characterized by unilateral pain and cranial autonomic symptoms. However, associated autonomic symptoms have also been reported in other headaches and facial pains, e.g. trigeminal neuralgia, with the clinical differentiation proving a complex task.
A 54-year-old man presented with right-sided, sharp, intense facial pain in the distribution area of the trigeminal nerve. Pain duration was from seconds to a few minutes, and trigger factors included ipsilateral touching of the skin and hair. Over the next ten years, symptoms progressed and changed presentation, also displaying as right-sided, severe, orbital pain, lasting 60 to 90 minutes, with conjunctival injection and rhinorrhea. Neurological examination was normal. Numerous medications were tried with limited or no effect. In 2010, magnetic resonance imaging revealed a right-sided deviation of the basilar artery at the level of pons, creating neurovascular contact with the trigeminal nerve. Microvascular decompression was performed, and symptoms resolved within days.
Differentiating between trigeminal autonomic cephalalgias and trigeminal neuralgia with autonomic symptoms can be challenging. The distinct change and evolution over time in the clinical presentation of the patient's head pain suggests a temporal plasticity of the pain in head and facial syndromes, irrespective of underlying pathoanatomic features.
三叉自主神经性头痛是一类以单侧疼痛和颅部自主神经症状为特征的原发性头痛。然而，在其他头痛和面部疼痛（如三叉神经痛）中也有自主神经症状的报道，临床鉴别是一项复杂的任务。
一名54岁男性，在三叉神经分布区域出现右侧尖锐、剧烈的面部疼痛。疼痛持续时间从数秒到几分钟不等，触发因素包括同侧皮肤和头发的触碰。在接下来的十年里，症状逐渐发展并改变表现，还表现为右侧严重的眼眶疼痛，持续60至90分钟，伴有结膜充血和流涕。神经系统检查正常。尝试了多种药物，效果有限或无效。2010年，磁共振成像显示脑桥水平基底动脉右侧偏移，与三叉神经形成神经血管接触。进行了微血管减压术，症状在数天内缓解。
鉴别三叉自主神经性头痛和伴有自主神经症状的三叉神经痛可能具有挑战性。患者头痛临床表现随时间的明显变化和演变提示头面部综合征疼痛具有时间可塑性，而与潜在的病理解剖特征无关。
