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