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Epicrania fugax combining forward and backward paroxysms in the same patient: the first four cases

Authors Barón-Sánchez J, Gutiérrez-Viedma Á, Ruiz-Piñero M, Pérez-Pérez A, Guerrero ÁL, Cuadrado ML

Received 28 February 2017

Accepted for publication 17 May 2017

Published 23 June 2017 Volume 2017:10 Pages 1453—1456


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr E Alfonso Romero-Sandoval

Johanna Barón-Sánchez,1 Álvaro Gutiérrez-Viedma,2 Marina Ruiz-Piñero,1 Alicia Pérez-Pérez,2 Ángel Luis Guerrero,1,3 María L Cuadrado2,4

1Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; 2Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain; 3Department of Medicine, School of Medicine, Universidad de Valladolid, Valladolid, Spain; 4Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain

Background: The first description of epicrania fugax (EF) reported brief painful paroxysms that start in posterior regions of the scalp and move forward to reach the ipsilateral forehead, eye, or nose. A backward variation, wherein pain stems from frontal areas and radiates to the posterior scalp, has also been acknowledged. We report four patients with features reminiscent of EF and the coexistence of forward and backward pain paroxysms.
Methods: We considered all patients attending the headache outpatient office at two tertiary hospitals from March 2008 to March 2016. We enrolled four patients with paroxysms fulfilling criteria for EF and a combination of forward and backward radiations.
Results: In all cases, pain paroxysms moved both in forward and backward directions with either a zigzag (n=2) or linear (n=2) trajectory. Three patients presented two stemming points, in the occipital scalp and forehead (n=2) or in the parietal area and eye (n=1), whereas the fourth patient only had a stemming point located in the parietal region. Pain quality was mainly stabbing, and its intensity was moderate (n=1) or severe (n=3). The duration of the paroxysms was highly variable (3–30 seconds), and two patients reported autonomic symptoms.
Conclusion: The clinical picture presented by our patients does not fit with other types of known headache or neuralgia syndromes; we propose it corresponds to a bidirectional variant of EF.

Keywords: epicrania, epicranial neuralgias, backward radiation, forward radiation

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