Department of Neurology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.
Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal.
Headache. 2021 Feb;61(2):392-395. doi: 10.1111/head.14043. Epub 2021 Jan 12.
OBJECTIVES/BACKGROUND: Auriculotemporal neuralgia is a rare headache disorder. Anesthetic nerve blockade seems to be effective in most cases; however, literature is scarce about the management of refractory cases.
Case report.
We report a 44-year-old woman with migraine without aura presented with moderate-to-severe right temporoparietal headache. The pain was refractory to multiple pharmacological strategies, including intravenous analgesia. A more throughout examination lead to the diagnosis of auriculotemporal neuralgia and anesthetic nerve blocks were performed. Due to early pain recrudescence, botulinum toxin (BoNT) was tried with better and longstanding pain control.
BoNT may be a useful treatment option in refractory auriculotemporal neuralgia. The best approach is yet to be established; however, the "follow-the-pain" protocol may be a reasonable option.
目的/背景：耳颞神经痛是一种罕见的头痛疾病。麻醉神经阻滞似乎对大多数病例有效；然而，关于难治性病例的治疗方法文献较少。
病例报告。
我们报告了一例 44 岁女性，偏头痛不伴先兆，表现为中度至重度右颞顶头痛。疼痛对多种药物治疗策略（包括静脉内镇痛）均有抵抗。更全面的检查导致诊断为耳颞神经痛，并进行了麻醉神经阻滞。由于早期疼痛复发，尝试使用肉毒毒素（BoNT），疼痛得到了更好和持久的控制。
BoNT 可能是难治性耳颞神经痛的一种有效治疗选择。最佳方法尚待确定；然而，“跟随疼痛”的方案可能是一个合理的选择。
