Pain Paroxysms With Coronal Radiation: Case Series and Proposal of a New Variant of Epicrania Fugax

Abstract

Our patients presented with a paroxysmal head pain that might correspond to a transverse variant of EF. These observations may not only expand the EF phenotype but also reinforce the distinction between EF and pericranial neuralgias.

Paroxysmal headache with extracephalic irradiation: Proposal for a new variant of epicrania fugax in a series of five patients

“…Although most patients may be included among forward or backward EF, there have been some reports of patients with a paroxysmal EF-type pain whose topographical features deviate from the current diagnostic criteria of the ICHD-3. Among these atypical cases, one had a sagittal trajectory (7), four had coronal trajectories (8), and one had paroxysms running in multiple directions (9). A facial variant of EF has also been described in 15 patients, with the pain crossing several dermatomes of the face in an upward or downward direction (10–12).…”

Epicrania fugax originating from a surgical scar of the scalp

“…6 The hypothesis of a possible central generator would be further reinforced by the existence of EF cases in which pain can originate at different points and travel along different trajectories. [8][9][10][11][12] EF is probably not a purely "peripheral" or purely "central" disorder. The genesis of pain could rely on peripheral generators (epicranial or intracranial) or, alternatively, on CNS generators.…”

Epicranial headaches part 2: Nummular headache and epicrania fugax

“…Episodes of transverse or coronal irradiation, from one side of the head to the other, have been described in four patients (Figure 6e); one of them also had typical EF episodes with posteroanterior irradiation (118). One of the most striking published cases had paroxysms with zigzag trajectories in multiple directions (Figure 6f).…”

“…As mentioned above, several cases have been described secondary to posterior fossa lesions, including a meningioma adjacent to the trigeminal root (124), a brainstem infarction (125), and a cerebellar abscess (126). The hypothesis of a possible central generator would be reinforced by the existence of EF cases in which pain can initiate at different points and follow different trajectories (75,116,118,119,122). Conceivably, EF is neither a purely peripheral nor a purely central disorder; the origin of pain could probably lie in both peripheral (extracranial or intracranial) and central generators.…”