FG Barker

Headache Classification Committee of the International Headache Society (IHS)

HN Simms

Ida Wibrandt

JA Pareja

M Leone

M Williams

Messoud Ashina

O Sjaastad

Per Rochat

PJ Jannetta

RM Sesso

S Maarbjerg

S Sebastian

Sabrina Khan

TJ Lovely

V Favoni

Journal of Headache and Pain

Abstract
          
            Background
            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.
          
          
            Case
            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.
          
          
            Conclusion
            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.
          </jats:sec

Crossref

The Journal of Headache and Pain

The temporal evolution of a facial pain syndrome associated with neurovascular contact: a case report

The temporal evolution of a facial pain syndrome associated with neurovascular contact: a case report

Abstract

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