A carotidynia is a syndrome of vascular neck pain or tenderness arising from one or both carotid artery which is frequently associated with various forms of extracranial vascular headache, Carotidynia is a common but infrequently recognized syndrome. Careful history taking, physical examination and appropreate Lab(ex: CT scan of neck) may be indicated for accurate diagnosis and adequate management. We experienced a case of carotidynia which was believed to be related to a carotid arteritis evidenced by elevated ESR, abnormalities of neck CT, angiogram, and good response to steroid.
Arteritis ; Carotid Arteries ; Diagnosis ; Neck ; Neck Pain ; Physical Examination ; Tomography, X-Ray Computed ; Vascular Headaches

Since the EEG study is without harm and pain, it has often been applied to headache sufferers,and many articles have been reported on the findings therefrom in other countries, but rare in Korea. An analysis of clinical and EEG features in 980 headache subjects in National Medical Center is presented. 1. In 980 cases of headache, 542 cases are female and about two thirds of the patients are between 20 and 49 years of age. 2. The distribution of patients contains functional headache (368 cases), tension headache (221 cases). Vascular headache (201 cases) and headache by organic brain diseases (93 cases) in orders. 3. The incidence of EEG abnormalities is 15.1% (147 cases) and most of the findings are dysrrhythmia I or II. The generalized abnormality is more common than focal. 4. Abnormal EEG findings are most common in patients with headache with seizure disorder (54.7%), followed by organic brain diseases (47.3%), and vascular headache (15.3%). In contrast, functional headache and tension headache reveal very low occurrence of EEG abnormalities. 5. There is a tendency of reverse relationship between symptom duration and incidence of EEG abnormalities but no close relationship between the characters of headache and EEG findings.
Brain Diseases ; Electroencephalography* ; Epilepsy ; Female ; Headache* ; Humans ; Incidence ; Korea ; Tension-Type Headache ; Vascular Headaches

The intracranial blood vessels of the dura and the pia receive sensory afferent innervations from trigeminal nerve which has been believed to play a critical role in the mediation of vascular headache such as migraine. The purpose of this study was to discover the mechanism by which the interaction between trigeminal ganglion neurons and the function of cerebral blood vessels. Using electrophysiological recording, we studied the responses of trigeminal ganglion neurons to electrical stimulation of middle meningeal artery(MMA), superior sagittal sinus(SS) and transverse sinus(TS) in rats. Sumatriptan is a highly selective agonist for 5-HT1D receptor subtype which mediates vasoconstriction of cerebral blood vessels. We observed responses to electrical stimulation in trigeminal ganglion neurons and meningeal blood flow(MBF) after intravenous injection of sumatriptan. The results were as follows: 1) The presumed mean conduction velocities of the cells activated MMA, SS and TS by electrical stimulation were approximately 1.5, 2.9 and 2.9m/s, respectively. These were presumed to be nociceptive small myelinated or unmylinated sensory fibers. 2) The action potential discharges of trigeminal ganglion neurons on MMA, SS and TS in the experimental control groups were 671+/-39.49, 856+/-63.95 and 494+/-21.54microV, respectrely. The action potential discharges of sumatriptan groups on MMA, SS and TS(393+/-20.10, 562+/-32.26 and 262+/-18.94microV, respectively) were significantly decreased compared to that of the experimental control groups. 3) The mean MBF of normal control group was 63.29+/-7.54ml/100g/min. The mean MBF of the experimental control groups on MMA, SS and TS were 97.13+/-9.91, 104.28+/-12.54 and 91.82+/-6.41ml/100g/min, respectively(p<0.05). MBF of sumatriptan group before stimulation was significantly decreased(compared to normal: 37.17+/-4.76ml/100g /min vs 63.29+/-7.54ml/100g/min). The mean MBF of sumatriptan groups on MMA, SS and TS were 57.11+/-4.48, 66.56+/-6.23 and 56.07+/-5.00ml/100g/min, respectively. Compared to that of the experimental control groups, the MBF of the sumatriptan groups were significantly decreased. In conclusion, the activation of trigeminal sensory afferents by the electrical stimulation of the dural vessel may create vasodilatation and increase cerebral blood flow which may lead to vascular headaches via trigeminal ganglion to brain stem This pathway can be important for understanding the neural mechanism for the development of pharmacological and surgical approach to alleviate vascular headache.
Action Potentials ; Animals ; Blood Vessels ; Brain Stem ; Electric Stimulation ; Headache ; Injections, Intravenous ; Meningeal Arteries* ; Migraine Disorders ; Myelin Sheath ; Negotiating ; Neurons* ; Rats* ; Receptor, Serotonin, 5-HT1D ; Sumatriptan ; Superior Sagittal Sinus* ; Trigeminal Ganglion* ; Trigeminal Nerve ; Vascular Headaches ; Vasoconstriction ; Vasodilation