Abstract text (incl. figure legends and references)

Background

Epicrania fugax (EF) is a primary headache of recent description. EF essentially consists of brief paroxysms of pain describing a linear or zigzag trajectory across the surface of one hemicranium, beginning and terminating in the territories of different nerves(1).

Materials and methods

We present a case report that illustrates the possibility of presenting a headache with the characteristics of EF, but which is presumably produced secondary to demyelination plaques due to multiple sclerosis.

Results

Patient with a history of multiple sclerosis receiving treatment with glatiramer acetate, with periventricular, subcortical and infratentorial white matter lesions (Figure 1), who reports that for 6 days he has presented pain in the territory of the three branches of the right trigeminal nerve of short duration and electrical characteristic, which is becoming more frequent and longer (4-5 seconds). There is no trigger point. By expressly delimiting the area, he refers that it begins at the level of the vertex, with a rapid path towards the chin. Normal neurological examination.

With these data, a forward EF diagnosis is made. Anesthetic blockade with bupivacaine was performed on both major suboccipital nerves and Lamotrigine 75 mg/day was prescribed (with progressive dose escalation over six weeks).

At the check-up after three months, the patient reports the complete resolution of his symptoms

Conclusions

The correct characterization of a secondary headache can improve our management. In the previous case, an anesthetic block is performed and lamotrigine is prescribed. Despite the scant evidence collected to date, this management would be correct for a primary EF, and in the same way it has been useful for the patient.

References

Square ML, Guerrero AL, Couple JA. Epicrania Fugax. Curr Pain Headache Rep. 2016 Apr;20(4):21. doi: 10.1007/s11916-016-0557-9. PMID: 26893151.