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Epicrania Fugax

  • Uncommon and/or Unusual Headaches and Syndromes (J Ailani, Section Editor)
  • Published:
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Abstract

Epicrania fugax (EF) is a primary headache of recent description. EF essentially consists of brief paroxysms of pain describing a linear or zigzag trajectory across the surface of one hemicranium, commencing and terminating in the territories of different nerves. The pain of forward EF originates in a particular area of the occipital, parietal or temporal regions and moves anteriorly, whereas the pain of backward EF originates in the frontal area, the eye or the nose and moves posteriorly. Some patients have ocular or nasal autonomic accompaniments, and some have triggers. Between attacks, many patients have continuous or intermittent pain and/or tenderness at the stemming area. Pain frequency is extremely variable and some patients have spontaneous remissions. Preventive therapy is required when the paroxysms are frequent and non-remitting. Neuromodulators, indomethacin, amitryptiline, nerve anesthetic blockades, and trochlear steroid injections have been used in different cases, with partial or complete response.

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References

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  1. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.

    Article  Google Scholar 

  2. Pareja JA, Cuadrado ML, Fernández-de-las-Peñas C, Caminero AB, Nieto C, Sánchez C, et al. Epicrania fugax: an ultrabrief paroxysmal epicranial pain. Cephalalgia. 2008;28:257–63.

    Article  CAS  PubMed  Google Scholar 

  3. Cuadrado ML, Gómez-Vicente L, Porta-Etessam J, Marcos-de-Vega MA, Parejo-Carbonell B, Matías-Guiu J. Paroxysmal head pain with backward radiation: will epicrania fugax go in the opposite direction? J Headache Pain. 2010;11:75–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Guerrero AL, Cuadrado ML, Porta-Etessam J, García-Ramos R, Gómez-Vicente L, Herrero S, et al. Epicrania fugax: ten new cases and therapeutic results. Headache. 2010;50:451–8.

    Article  PubMed  Google Scholar 

  5. Fontalba-Navas M, Arjona-Padillo A. Un caso de cefalea atípica con evolución de cefalea numular a epicrania fugax. Neurologia. 2011;26:60–1 [letter].

    Article  CAS  PubMed  Google Scholar 

  6. Herrero-Velázquez S, Guerrero-Peral AL, Mulero P, Peñas-Martínez ML, Cortijo E, Miranda S, et al. Epicrania fugax: características clínicas de una serie de dieciocho pacientes. Rev Neurol. 2011;53:531–7.

    PubMed  Google Scholar 

  7. Mulero P, Guerrero AL, Herrero-Velázquez S, Cortijo E, Pedraza M, Peñas ML, et al. Epicrania fugax with backward radiation: clinical characteristics of nine new cases. J Headache Pain. 2011;12:535–9. Report of a series of patients with backward epicrania fugax whose clinical characteristics were similar to those of a series of patients with forward epicrania fugax.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Herrero-Velázquez S, Guerrero AL, Pedraza MI, Mulero P, Ayllón B, Ruiz-Piñero M, et al. Nummular headache and epicrania fugax: possible association of epicranias in eight patients. Pain Med. 2013;14:358–61. Report on the possible association of nummular headache and epicrania fugax in some patients.

    Article  PubMed  Google Scholar 

  9. Cuadrado ML, Ordás CM, Sánchez-Lizcano M, Casas-Limón J, Matías-Guiu JA, García-García ME, et al. Epicrania fugax: 19 cases of an emerging headache. Headache. 2013;53:764–74. Description of a large clinical series of epicrania fugax and review of all previous cases reported in the literature.

    Article  PubMed  Google Scholar 

  10. Jin P, Wang Y. Atypical cluster and migraine headache starting with a reverse epicrania fugax. Pain Med. 2013;14:765–6.

    Article  PubMed  Google Scholar 

  11. Cuadrado ML, Aledo-Serrano Á, Ruiz-Álvarez L. Eslicarbazepine acetate for a patient with highly resistant epicrania fugax. Pain Pract. 2015;15:E27.

    Article  PubMed  Google Scholar 

  12. Ordás-Bandera CM, Prieto-Jurczynska C, Martín-Gil L, Díez-Barrio A, Murcia-García FJ, Pardo-Moreno J. Epicrania fugax como forma de inicio de ataques de migraña. Rev Neurol. 2015;61:191–2.

    PubMed  Google Scholar 

  13. De Lera-Alfonso MC, Ruiz Piñero M, Avellón-Liaño H, Martínez-Velasco E, Barón Sánchez J, Juanatey-García A, et al. Epicrania fugax: motivos de derivación e historia natural en una serie de 57 pacientes. LXVII Reunión Anual de la Sociedad Española de Neurología, p. 17. http://www.sen.es/publicaciones [Accessed 4 Jan 2016].

  14. De la Cruz C, Herrero-Velázquez S, Ruiz M, Pedraza MI, Mulero P, Barón J, et al. Epicrania fugax with sagittal trajectory of the pain. Pain Med. 2015;16:1238–9.

    Article  PubMed  Google Scholar 

  15. De Lera M, Aledo-Serrano A, Liaño T, Ruiz M, Pedraza M, Guerrero AL, et al. ¿Es posible la irradiación transversal de la epicrania fugax? Reflexiones a propósito de dos casos. Neurología 2014; 29 (Espec Congr):203 [abstract].

  16. Cuadrado ML, Aledo-Serrano A, Di Capua D, Pareja JA. A multidirectional epicrania fugax. Cephalalgia. 2015;35:835–6.

    Article  PubMed  Google Scholar 

  17. Pareja JA, Bandrés P. Linear interictal pain in epicrania fugax. J Headache Pain. 2015;16:507.

    Article  PubMed  Google Scholar 

  18. Cuadrado ML, Aledo-Serrano Á, Jiménez-Almonacid J, de Lera M, Guerrero ÁL. Facial pain radiating upwards: could the pain of epicrania fugax start in the lower face? Headache. 2015;55:690–5. First description of a facial variant of epicrania fugax in five patients.

    Article  PubMed  Google Scholar 

  19. Gutiérrez-Viedma A, Aledo-Serrano A, García-Moreno H, García-Azorín D, Orviz A, Cuadrado ML. Epicrania fugax facial: delimitando las características clínicas de una entidad de reciente descripción. LXVII Reunión Anual de la Sociedad Española de Neurología, p. 9. http://www.sen.es/publicaciones [Accessed 4 Jan 2016].

  20. Pareja JA, Caminero AB, Serra J, Barriga FJ, Barón M, Dobato JL, et al. Sánchez del Río M Numular headache: a coin-shaped cephalgia. Neurology. 2002;58:1678–9.

    Article  CAS  PubMed  Google Scholar 

  21. Ruscheweyh R, Buchheister A, Gregor N, Jung A, Evers S. Nummular headache: six new cases and lancinating pain attacks as possible manifestation. Cephalalgia. 2010;30:249–53.

    CAS  PubMed  Google Scholar 

  22. Guerrero AL, Cortijo E, Herrero-Velázquez S, Mulero P, Miranda S, Peñas ML, et al. Nummular headache with and without exacerbations: comparative characteristics in a series of 72 patients. Cephalalgia. 2012;32:649–53.

    Article  PubMed  Google Scholar 

  23. Schwartz DP, Robbins MS, Grosberg BM. Nummular headache update. Curr Pain Headache Rep. 2013;17:340.

    Article  PubMed  Google Scholar 

  24. Pareja JA, Ruiz J, de la Isla C, Al-Sabbah H, Espejo J. Idiopathic stabbing headache (jabs and jolts syndrome). Cephalalgia. 1996;16:93–6.

    Article  CAS  PubMed  Google Scholar 

  25. Fuh JL, Kuo KH, Wang SJ. Primary stabbing headache in a headache clinic. Cephalalgia. 2007;21:1005–9.

    Article  Google Scholar 

  26. Guerrero AL, Herrero S, Peñas ML, Cortijo E, Rojo E, Mulero P, et al. Incidence and influence on referral of primary stabbing headache in an outpatient headache clinic. J Headache Pain. 2011;12:311–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Hagler S, Ballaban-Gil K, Robbins MS. Primary stabbing headache in adults and pediatrics: a review. Curr Pain Headache Rep. 2014;18:450.

    Article  PubMed  Google Scholar 

  28. Sjaastad O, Saunte C, Salvesen R, Fredriksen TA, Seim A, Røe OD, et al. Shortlasting, unilateral, neuralgiform headache attacks with conjuntival injection, tearing, sweating and rhinorrhea. Cephalalgia. 1989;9:147–56.

    Article  CAS  PubMed  Google Scholar 

  29. Pareja JA, Cuadrado ML. SUNCT syndrome: an update. Expert Opin Pharmacother. 2005;6:591–9.

    Article  CAS  PubMed  Google Scholar 

  30. Cohen AS, Matharu MS, Goadsby P. Shortlasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or cranial autonomic features (SUNA). A prospective clinical study of SUNCT and SUNA. Brain. 2006;129:2746–60.

    Article  PubMed  Google Scholar 

  31. Pomeroy JL, Nahas SJ. SUNCT/SUNA: a review. Curr Pain Headache Rep. 2015;19:38.

    Article  PubMed  Google Scholar 

  32. Hammons SR, Danta A. Occipital neuralgia. Clin Exp Neurol. 1978;15:258–70.

    Google Scholar 

  33. Vanelderen P, Lataster A, Levy R, Mekhail N, van Kleef M, Van Zundert J. Occipital neuralgia. Pain Pract. 2010;10:137–44.

    Article  PubMed  Google Scholar 

  34. Dougherty C. Occipital neuralgia. Curr Pain Headache Rep. 2014;18:411.

    Article  PubMed  Google Scholar 

  35. Sjaastad O, Stolt-Nielsen A, Pareja JA, Fredriksen TA, Vincent M. Supraorbital neuralgia. On the clinical manifestations and a possible therapeutic approach. Headache. 1999;39:204–12.

    Article  CAS  PubMed  Google Scholar 

  36. Pareja JA, Caminero AB. Supraorbital neuralgia. Curr Pain Headache Rep. 2006;10:302–5.

    Article  PubMed  Google Scholar 

  37. Mulero P, Guerrero AL, Pedraza M, Herrero-Velázquez S, de la Cruz C, Ruiz M, et al. Non-traumatic supraorbital neuralgia: a clinical study of 13 cases. Cephalalgia. 2012;32:1150–3.

    Article  PubMed  Google Scholar 

  38. Afridi SK, Shields KG, Bhola R, Goadsby PJ. Greater occipital nerve injection in primary headache syndromes—prolonged effects from a single injection. Pain. 2006;122:126–9.

    Article  CAS  PubMed  Google Scholar 

  39. Blumenfeld A, Ashkenazi A, Napchan U, Bender SD, Klein BC, Berliner R, et al. Expert consensus recommendations for the performance of peripheral nerve blocks for headaches—a narrative review. Headache. 2013;53:437–46.

    Article  PubMed  Google Scholar 

  40. Harris W. An analysis of 1433 cases of paroxysmal trigeminal neuralgia (trigeminal tic) and the end-results of Gasserian alcohol injection. Brain. 1940;63:209–24.

    Article  Google Scholar 

  41. Katusic S, Beard CM, Bergstrahl E, Kurland LT. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945–1984. Ann Neurol. 1990;27:89–95.

    Article  CAS  PubMed  Google Scholar 

  42. Bowsher D. Trigeminal neuralgia: a symptomatic study on 126 successive patients with and without previous intervention. Pain Clin. 2000;12:93–101.

    Article  Google Scholar 

  43. Cheshire Jr WP. Trigeminal neuralgia. Curr Pain Headache Rep. 2007;11:69–74.

    Article  PubMed  Google Scholar 

  44. Becser N, Bovim G, Sjaastad O. Extracranial nerves in the posterior part of the head. Anatomic variations and their possible clinical significance. Spine. 1998;23:1435–41.

    Article  CAS  PubMed  Google Scholar 

  45. Andersen NB, Bovim G, Sjaastad O. The frontotemporal peripheral nerves of the head. Topographic variations of the supraorbital, supratrochlear and auriculotemporal nerves and their possible clinical significance. Surg Radiol Anat. 2001;23:97–104.

    Article  CAS  PubMed  Google Scholar 

  46. Favoni V, Grimaldi D, Pierangeli G, Cortelli P, Cevoli S. SUNCT/SUNA and neurovascular compression: new cases and critical literature review. Cephalalgia. 2013;33:1337–48.

    Article  PubMed  Google Scholar 

  47. Antonini G, Di Pasquale A, Cruccu G, Truini A, Morino S, Saltelli G, et al. Magnetic resonance imaging contribution for diagnosing symptomatic neurovascular contact in classical trigeminal neuralgia: a blinded case–control study and meta-analysis. Pain. 2014;155:1464–71.

    Article  PubMed  Google Scholar 

  48. Devor M. Pathophysiological response of nerves to injury. In: McMahon SB, Koltzenburg M, Tracey I, Turk D, editors. Wall and Melzack’s textbook of pain. 5th ed. Philadelphia: Elsevier Saunders; 2013. p. 861–88.

    Google Scholar 

  49. Kerr FWL. Structural relation of the trigeminal spinal tract to upper cervical roots and the solitary nucleus in the cat. Exp Neurol. 1961;4:134–48.

    Article  CAS  PubMed  Google Scholar 

  50. Bartsch T, Goadsby PJ. The trigeminocervical complex and migraine: current concepts and synthesis. Curr Pain Headache Rep. 2003;7:371–6.

    Article  CAS  PubMed  Google Scholar 

  51. Evers S, Rahmann A, May A, Husstedt IW, Frese A. Parasympathetic activation in experimental trigeminal pain. In: Olesen J, Jensen TS, editors. From basic pain mechanisms to headache. New York: Oxford University Press; 2006. p. 113–6.

    Google Scholar 

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Acknowledgments

The drawings were made by Esperanza González-Perlado.

English editorial assistance was provided by Pedro López-Ruiz.

Author information

Authors and Affiliations

  1. Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain

    María Luz Cuadrado

  2. Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain

    María Luz Cuadrado

  3. Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain

    Angel L. Guerrero

  4. Department of Medicine, Universidad de Valladolid, Valladolid, Spain

    Angel L. Guerrero

  5. Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain

    Juan A. Pareja

  6. Department of Neurology, Hospital Universitario Quirón Madrid, Pozuelo de Alarcón, Madrid, Spain

    Juan A. Pareja

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  1. María Luz Cuadrado
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Correspondence to María Luz Cuadrado.

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María Luz Cuadrado, Angel L. Guerrero, and Juan A. Pareja declare that they have no conflict of interest.

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This article is part of the Topical Collection on Uncommon and/or Unusual Headaches and Syndromes

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Cuadrado, M.L., Guerrero, A.L. & Pareja, J.A. Epicrania Fugax. Curr Pain Headache Rep 20, 21 (2016). https://doi.org/10.1007/s11916-016-0557-9

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  • DOI: https://doi.org/10.1007/s11916-016-0557-9

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