Carotidynia

Aka: Carotidynia, Benign Carotidynia, Fay Syndrome, Extracranial Vascular Cephalea, Migrainous Carotidynia, Arteriosclerotic Carotidynia

1. Pathophysiology
   1. Unknown etiology
   2. Extracranial carotid dilatation results in pain
      1. Face, ear or Neck Pain
      2. Headache (cervicogenic Headache)
2. Types
   1. Classic Carotidynia (Benign Carotidynia, Fay Syndrome)
      1. Most common type of Carotidynia
      2. More common in age under 60 years
      3. Associations
         1. Cold weather
         2. Preceeding viral illness
   2. Migrainous Carotidynia
      1. Migraine Headache variant
      2. More often in women under age 60 years
   3. Arteriosclerotic Carotidynia
      1. Occurs over age 60 years
      2. Results from Carotid Artery Stenosis
      3. Must be ruled-out in patients at risk
3. Symptoms
   1. Sore Throat
   2. Unilateral Neck Pain
      1. Ache or throbbing
      2. Moderate to severe
      3. May be constant or episodic
   3. Radiation
      1. Jaw, ear, or face on affected side
   4. Provocative
      1. Chewing
      2. Head movement
      3. Valsalva Maneuver (yawn, cough, sneeze)
      4. Bending forward
   5. Associated symptoms with classic Carotidynia
      1. Malaise
      2. Nasal congestion
      3. Lacrimation
4. Symptoms: Red Flags suggestive of arteriosclerosis
   1. Cardiac Risk Factors
   2. Difficulty extending neck away from affected side
   3. Near Syncope sensation on forward flexion of neck
5. Signs
   1. Tenderness to palpation
      1. Carotid Artery course
      2. Mouth floor at facial artery, submandibular Ganglion
   2. Absent clinical findings
      1. No distinct Neck Mass
      2. No fever
      3. No temperomandibular Joint Pain
   3. Findings suggestive of arteriosclerosis
      1. Carotid Bruit
6. Differential Diagnosis
   1. Cervical Disc Disease
   2. Cluster Headache
   3. Chronic Paroxysmal Hemicrania
   4. Cervical Neck Pain
   5. Myofascial Pain Syndrome
   6. Temperomandibular joint syndrome
   7. Temporal Arteritis
   8. Pharyngitis or Tonsillitis
   9. Thyroiditis
   10. Sialolithiasis
   11. Mononucleosis
   12. Cervical adenitis
7. Evaluation
   1. Rule-out Carotid Artery Stenosis in patients at risk
8. Management
   1. Arteriosclerotic Carotidynia
      1. Treat as Carotid Artery Stenosis
   2. Classic Carotidynia
      1. Reassurance (Transient course)
      2. Local heat
      3. NSAIDs (e.g. Indomethacin 50 mg PO tid)
      4. Prednisone indicated for protracted course
         1. Dose: 40 mg PO qd tapered over 7-10 days
   3. Migrainous Carotidynia
      1. Consider Migraine Abortive Treatment (eg. Ergotamine)
      2. Consider Migraine Prophylaxis (e.g. Inderal, Elavil)
9. References
   1. Clark (1994) Am Fam Physician 50(5):987-90 [PubMed]
   2. Emmanuelli (1998) Ear Nose Throat J 77(6):462-9 [PubMed]