Abstract
Objectives
Hemicrania continua (HC) is one of the trigeminal autonomic cephalalgias (TAC), where sympathetic dysfunction and autonomic dysfunction resulting in parasympathetic over activation with some evidence of sympathetic inhibition have been suggested as probable causes. However, cases of hemicrania continua secondary to sympathetic dysfunction due to neurogenic paravertebral tumor impinging on the sympathetic chain has not been previously reported. In this case, the probability of the sympathetic dysfunction was more likely based on the clinical features and management.
Case presentation
A 23-year-old female presented with a chief complaint of right unilateral pain in the retro-bulbar, head and facial region for the past three years. An initial MRI of the brain was negative, whereas an MRI of the spine was advised to rule out a cervicogenic origin of the pain. The MRI revealed a well-defined mass lesion within right paravertebral region at T3 indicative of a neurogenic tumor. The patient was diagnosed with probable hemicrania continua secondary to neurogenic tumor impinging on adjacent sympathetic chain. A trial of indomethacin 75 mg/day was advised, which provided complete relief of the headache. The patient was referred to a neurologist for management of the neurogenic tumor.
Conclusions
Headache disorders may be secondary to pathologies and comprehensive evaluation and accurate diagnosis are essential. Knowledge of neuroanatomy is paramount to understand and explain underlying pathophysiological mechanisms. Multidisciplinary management is essential in complex orofacial cases.
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Research funding: None.
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Author contributions: Mythili Kalladka-conception, drafting and critical revision of the work and final approval; the acquisition, analysis, and interpretation of the case details; and drafting the work and revising it critically for important intellectual content; and agreement to be accountable for all aspects of the work. Osamah Al-azzawi-conception, drafting and critical revision of the work and final approval; the acquisition, analysis, and interpretation of the case details; and agreement to be accountable for all aspects of the work. Gary M Heir-conception, drafting and critical revision of the work and final approval; the acquisition, analysis, and interpretation of the case details and agreement to be accountable for all aspects of the work. Suresha Kodapala-conception, drafting and critical revision of the work and final approval; the acquisition, analysis, and interpretation of the case details and agreement to be accountable for all aspects of the work. Mohan Thomas Nainan conception, drafting and critical revision of the work and final approval; the acquisition, analysis, and interpretation of the case details and agreement to be accountable for all aspects of the work. Junad Khan-conception, drafting and critical revision of the work and final approval; the acquisition, analysis, and interpretation of the case details; and agreement to be accountable for all aspects of the work.
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Competing interest: None.
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Informed consent: Informed consent has been obtained from the patient.
References
1. Dahlhamer, J, Lucas, J, Zelaya, C, Nahin, R, Mackey, S, DeBar, L. Prevalence of chronic pain and high-impact chronic pain among adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–6. https://doi.org/10.15585/mmwr.mm6736a2.Search in Google Scholar PubMed PubMed Central
2. International Association for Study of Pain. Orofacial pain. Available at: https://www.iasp-pain.org/GlobalYear/OrofacialPain2013 [Accessed 12 Jan 2021].Search in Google Scholar
3. Schiffman, E, Ohrbach, R, Truelove, E, Look, J, Anderson, G, Goulet, JP. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network* and orofacial pain special interest Groupdagger. J Oral Facial Pain Headache 2014;28:6–27. https://doi.org/10.11607/jop.1151.Search in Google Scholar PubMed PubMed Central
4. Cittadini, E, Goadsby, PJ. Hemicrania continua: a clinical study of 39 patients with diagnostic implications. Brain 2010;133:1973–86. https://doi.org/10.1093/brain/awq137.Search in Google Scholar PubMed
5. Benoliel, R. Trigeminal autonomic cephalgias. Br J Pain 2012;6:106–23. https://doi.org/10.1177/2049463712456355.Search in Google Scholar PubMed PubMed Central
6. Villar-Martínez, MD, Moreno-Ajona, D, Chan, C, Goadsby, PJ. Indomethacin-responsive headaches-A narrative review. Headache 2021;61:700–14. https://doi.org/10.1111/head.14111.Search in Google Scholar PubMed
7. Eller, M, Goadsby, PJ. Trigeminal autonomic cephalalgias. Oral Dis 2016;22:1–8. https://doi.org/10.1111/odi.12263.Search in Google Scholar PubMed
8. Wei, DY, Yuan Ong, JJ, Goadsby, PJ. Overview of trigeminal autonomic cephalalgias: nosologic evolution, diagnosis, and management. Ann Indian Acad Neurol 2018;21:39–44.10.4103/aian.AIAN_348_17Search in Google Scholar PubMed PubMed Central
9. Benoliel, R, Robinson, S, Eliav, E, Sharav, Y. Hemicrania continua. J Orofac Pain 2002;16:317–25.Search in Google Scholar
10. Burish, MJ, Rozen, TD. Trigeminal autonomic cephalalgias. Neurol Clin 2019;37:847–69. https://doi.org/10.1016/j.ncl.2019.07.001.Search in Google Scholar PubMed
11. Elias, M. Cervical sympathetic and stellate ganglion blocks. Pain Physician 2000;3:294–304. https://doi.org/10.36076/ppj.2000/3/294.Search in Google Scholar
12. Klein, RN, Burk, DT, Chase, PF. Anatomically and physiologically based guidelines for use of the sphenopalatine ganglion block versus the stellate ganglion block to reduce atypical facial pain. Cranio 2001;19:48–55. https://doi.org/10.1080/08869634.2001.11746151.Search in Google Scholar PubMed
13. Kommuru, H, Jothi, S, Bapuji, P, Sree, D, Antony, J. Thoracic part of sympathetic chain and its branching pattern variations in South Indian cadavers. J Clin Diagn Res 2014;8:09–12. https://doi.org/10.7860/JCDR/2014/9274.5246.Search in Google Scholar PubMed PubMed Central
14. Nesbitt, AD, Goadsby, PJ. Cluster headache. BMJ 2012;344:2407. https://doi.org/10.1136/bmj.e2407.Search in Google Scholar PubMed
15. van Vliet, JA, Eekers, PJ, Haan, J, Ferrari, MD. Dutch RUSSH Study Group. Features involved in the diagnostic delay of cluster headache. J Neurol Neurosurg Psychiatry 2003;74:1123–5. https://doi.org/10.1136/jnnp.74.8.1123.Search in Google Scholar PubMed PubMed Central
16. Klapper, JA, Klapper, A, Voss, T. The misdiagnosis of cluster headache: a nonclinic, population‐based, Internet survey. Headache 2000;40:730–5. https://doi.org/10.1046/j.1526-4610.2000.00127.x.Search in Google Scholar PubMed
17. Van Alboom, E, Louis, P, Van Zandijcke, M, Crevits, L, Vakaet, A, Paemeleire, K. Diagnostic and therapeutic trajectory of cluster headache patients in Flanders. Acta Neurol Belg 2009;109:10.Search in Google Scholar
18. Bahra, A, May, A, Goadsby, PJ. Cluster headache: a prospective clinical study with diagnostic implications. Neurology 2002;58:354–61. https://doi.org/10.1212/wnl.58.3.354.Search in Google Scholar PubMed
19. Khan, J, Sood, R, Anwer, M, Kalladka, M. Duloxetine for the management of sensory and taste alterations, following iatrogenic damage of the lingual and chorda tympani nerve. Scand J Pain 2021;21:194–9.10.1515/sjpain-2020-0066Search in Google Scholar PubMed
20. Rossi, P, Faroni, J, Tassorelli, C, Nappi, G. Diagnostic delay and suboptimal management in a referral population with hemicrania continua. Headache 2009;49:227–34. https://doi.org/10.1111/j.1526-4610.2008.01260.x.Search in Google Scholar PubMed
21. Costa, YM, Conti, PC, de Faria, FA, Bonjardim, LR. Temporomandibular disorders and painful comorbidities: clinical association and underlying mechanisms. Oral Surg Oral Med Oral Pathol Oral Radiol 2017;123:288–97. https://doi.org/10.1016/j.oooo.2016.12.005.Search in Google Scholar PubMed
22. Romero-Reyes, M, Uyanik, JM. Orofacial pain management: current perspectives. J Pain Res 2014;7:99. https://doi.org/10.2147/jpr.s37593.Search in Google Scholar
23. Fernandes, G, Arruda, MA, Bigal, ME, Camparis, CM, Gonçalves, DAG. Painful temporomandibular disorder is associated with migraine in adolescents: a case-control study. J Pain 2019;20:1155–63. https://doi.org/10.1016/j.jpain.2019.03.010.Search in Google Scholar PubMed
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