Epicrania Fugax: Ten New Cases and Therapeutic Results

Peral, Á.L. Guerrero; Cuadrado, María‐Luz; Porta‐Etessam, Jesús; García-Ramos, R.; Gómez-Vicente, Lidia; Herrero, Sonia; Peñas, María L.; Fernández, Rosa

doi:10.1111/j.1526-4610.2009.01607.x

Cited by 35 publications

(51 citation statements)

References 29 publications

(32 reference statements)

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“…We registered all the demographic and clinical data of these patients. We included in the analysis characteristics of 6 patients previously described [2]. …”

Section: Methodsmentioning

confidence: 99%

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Epicrania fugax with backward radiation: clinical characteristics of nine new cases

et al. 2011

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Epicrania fugax (EF) is a novel syndrome, described as a paroxysmal and brief head pain, starting in posterior cranial regions and rapidly spreading forward ipsilateral eye, nose or forehead. Two patients with comparable clinical features stemming from frontal scalp to ipsilateral posterior regions have been recently described and proposed as backward radiation epicrania fugax (BREF). We report a new series of nine BREF and compare their clinical characteristics with 18 forward radiation EF (FREF). Since first description of BREF in February 2010 we have assessed nine patients (four males, five females) with this clinical picture at an outpatient headache office in a Tertiary Hospital. Comparison is established with 18 FREF patients (6 males, 12 females), attended since the publication of first series of EF in March 2008. We found no differences between BREF and FREF, respectively, in age at onset (43.4 ± 13.1 vs. 42.5 ± 17.7 years), female/male ratio (5/4 vs. 12/6), pain intensity (6.9 ± 2.1 vs. 6.8 ± 2.1 in a 0–10 visual analogical scale), duration (7.1 ± 4.9 vs. 5.7 ± 4.3 s) and frequency of episodes per day (7 ± 8.4 vs. 9.9 ± 15.4). Patients in BREF group presented less frequently interictal pain in stemming point (22.2 vs. 55.5%) and accompanying autonomic signs (33.3 vs. 55.5%), but without statistical significance in both the cases. This series reinforces the proposal of EF as a new headache variant or a new headache syndrome. Clinical picture of brief pain paroxysms starting in the anterior scalp and radiating backwards does not fit known headaches or neuralgias and might correspond to a reverse variant of EF, clinical characteristics of which are comparable to FREF.

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“…We registered all the demographic and clinical data of these patients. We included in the analysis characteristics of 6 patients previously described [2]. …”

Section: Methodsmentioning

confidence: 99%

“…To this first series, 15 new patients with the same clinical features have been added, so reinforcing the proposal of EF as a new headache variant or a new headache syndrome [2–4]. Recently, two patients who fulfilled all the characteristics for EF except the direction of radiation have been reported.…”

Section: Introductionmentioning

confidence: 92%

Epicrania fugax with backward radiation: clinical characteristics of nine new cases

et al. 2011

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“…Epicrania fugax (EF) has been recently classified as a primary headache in the appendix of the International Classification of Headache Disorders, 3rd edition, beta version . Since EF was first proposed as a new syndrome by Pareja et al in 2008, more than 60 cases have been reported . The essential feature of EF is the occurrence of dynamic painful paroxysms, with a quick and ample movement through the surface of one side of the head.…”

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confidence: 99%

Facial Pain Radiating Upwards: Could the Pain of Epicrania Fugax Start in the Lower Face?

et al. 2014

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“…Initial descriptions depicted a unilateral pain spreading from posterior cranial areas to the ipsilateral anterior scalp, following a linear or zigzag trajectory – that is the classical forward EF 1,5. Later on, a backward EF – with pain radiating from frontal areas toward the posterior scalp – was also described, with no demographic or clinical differences between both variants 6–8.…”

Section: Introductionmentioning

confidence: 99%

Epicrania fugax combining forward and backward paroxysms in the same patient: the first four cases

Barón-Sánchez¹,

Gutiérrez-Viedma²,

Ruiz-Piñero³

et al. 2017

JPR

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BackgroundThe first description of epicrania fugax (EF) reported brief painful paroxysms that start in posterior regions of the scalp and move forward to reach the ipsilateral forehead, eye, or nose. A backward variation, wherein pain stems from frontal areas and radiates to the posterior scalp, has also been acknowledged. We report four patients with features reminiscent of EF and the coexistence of forward and backward pain paroxysms.MethodsWe considered all patients attending the headache outpatient office at two tertiary hospitals from March 2008 to March 2016. We enrolled four patients with paroxysms fulfilling criteria for EF and a combination of forward and backward radiations.ResultsIn all cases, pain paroxysms moved both in forward and backward directions with either a zigzag (n=2) or linear (n=2) trajectory. Three patients presented two stemming points, in the occipital scalp and forehead (n=2) or in the parietal area and eye (n=1), whereas the fourth patient only had a stemming point located in the parietal region. Pain quality was mainly stabbing, and its intensity was moderate (n=1) or severe (n=3). The duration of the paroxysms was highly variable (3–30 seconds), and two patients reported autonomic symptoms.ConclusionThe clinical picture presented by our patients does not fit with other types of known headache or neuralgia syndromes; we propose it corresponds to a bidirectional variant of EF.

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Epicrania Fugax: Ten New Cases and Therapeutic Results

Abstract: 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.

Cited by 35 publications

References 29 publications

Epicrania fugax with backward radiation: clinical characteristics of nine new cases

Epicrania fugax with backward radiation: clinical characteristics of nine new cases

Facial Pain Radiating Upwards: Could the Pain of Epicrania Fugax Start in the Lower Face?

Epicrania fugax combining forward and backward paroxysms in the same patient: the first four cases

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