Linear headache: a recurrent unilateral head pain circumscribed in a line-shaped area

Abstract

BackgroundA headache circumscribed in a line-shaped area but not confined to the territory of one particular nerve had ever been described in Epicrania Fugax (EF) of which the head pain is moving and ultrashort. In a 25-month period from Feb 2012 to Mar 2014, we encountered 12 patients with a paroxysmal motionless head pain restricted in a linear trajectory. The head pain trajectory was similar to that of EF, but its all other features obviously different from those of EF. We named this distinctive but undescribed type of headache linear headache (LH).MethodsA detailed clinical feature of the headache was obtained in all cases to differentiate with EF, trigeminal autonomic cephalalgias (TACs) and cranial neuralgia. Similarities and differences in clinical features were compared between LH and migraine.ResultsThe twelve LH patients (mean age 43.9 ± 12.2) complained of a recurrent, moderate to severe, distending (n = 9), pressure-like (n = 3) or pulsating (n = 3) pain within a strictly unilateral line-shaped area. The painful line is distributed from occipital or occipitocervical region to the ipsilateral eye (n = 5), forehead (n = 6) or parietal region (n = 1). The pain line has a trajecory similar to that of EF but no characteristics of moving. The headache duration would be ranged from five minutes to three days, but usually from half day to one day in most cases (n = 8). Six patients had the accompaniment of nausea with or without vomiting, and two patients had the accompaniment of ipsilateral dizziness. The attacks could be either spontaneous (n = 10) or triggered by noise, depression and resting after physical activity (n = 1), or by stress and staying up late (n = 1). The frequency of attacks was variable. The patients had well response to flunarizine, sodium valproate and amitriptyline but not to carbamazepine or oxcarbazepine. LH is different from EF, trigeminal autonomic cephalalgias (TACs) and cranial neuralgia, but it had couple of features similar to that of migraine.ConclusionsThe clinical picture of LH might be a subtype of migraine, or represent a novel syndrome.

Linear interictal pain in Epicrania Fugax: a reply

“…Yes, this interictal pain and the EF pain described by Pareja and Bandrés topographically parallels to that in some of our LH patients. From the descriptions of our reported patients [ 1 ] and unreported patients, the LH pain areas are mainly localized in a lineal area linking the occipitocervical point and the internal canthus of the ipsilateral eye, with some in a lineal area little shorter than this “typical” linear trajectory in length. The LH pain area is similar to the pain trajectory of EF [ 4 , 5 ] and this was why we needed to differentiate it from EF in our article [ 1 ].…”

“…From the descriptions of our reported patients [ 1 ] and unreported patients, the LH pain areas are mainly localized in a lineal area linking the occipitocervical point and the internal canthus of the ipsilateral eye, with some in a lineal area little shorter than this “typical” linear trajectory in length. The LH pain area is similar to the pain trajectory of EF [ 4 , 5 ] and this was why we needed to differentiate it from EF in our article [ 1 ]. But, we do not think that the LH pain in our patients is an interictal pain of EF based on the following observations and considerations: 1) If the LH pain is an interictal pain of EF, the LH pain should, at least in some of our reported and unreported patients, be milder than the EF pain and the patients would describe the precedent ultrashort duration of more severe pain but the LH patients did not.…”

“…We thank Dr. Juan A. Pareja and Dr. Pablo Bandrés for their comments on our article [ 1 ]. They raise a question whether the linear headache (LH) we reported be a linear interictal pain in epicranial fugax (EF) while this interictal pain become the main complaint, based on a interesting case they encountered [ 2 ].…”

Linear interictal pain in Epicrania Fugax

“…Wang Y et al [ 5 ] described headaches with pain episodes localized in a line-shaped area of one hemicranium . Topographically, this description parallels that of our patient.…”

Epicránea fugax: propuesta de criterios diagnósticos de una cefalea emergente a partir del análisis de una serie de 59 pacientes

“…Recientemente Wang et al (2014) han propuesto también la posibilidad de que un dolor similar en cuanto a su topografía, pero estático y sin componente dinámico (llamado por los autores cefalea lineal) pueda ser considerado una variante de una EF. Pareja et al (2015), en una carta al director, expone su opinión al respecto (que el autor de esta tesis comparte).…”