Carotidynia: report of eight cases and prospective evaluation of therapy

Ultrasound for the Diagnosis of Carotidynia

The purpose of this work is to draw attention to the characteristic sonographic features of carotidynia, which, in the context of a typical clinical picture support its diagnosis. Six patients presented with primary symptoms of neck pain and focal tenderness. In all patients, focal wall thickening of the distal end of the common carotid artery was found exactly in the region of tenderness, leading to mild lumen narrowing. Treatment with nonsteroidal anti-inflammatory drugs or glucocorticoids led to full symptom resolution. Carotidynia will often be encountered first on sonography performed for evaluation of neck pain and has a characteristic sonographic appearance.

Less known non-infectious and neuromusculoskeletal system-originated anterolateral neck and craniofacial pain disorders

Pain syndromes of neuromusculoskeletal origin are not well-known by most of the clinicians working on head and neck area. As a result, most of the patients with these syndromes are either overlooked without having any treatment or they inappropriately have antibiotic treatments or surgical interventions such as dental extractions and tonsillectomies. Better recognition of the pain syndromes of the neck and face region or entities related to neuromusculoskeletal system may result in more appropriate and effective management of such conditions while avoiding unnecessary medical and surgical treatments. In this review, causes, clinical characteristics, diagnostic and treatment modalities of relatively less known craniofacial and neck pain entities including Eagle syndrome, carotidynia, glossopharyngeal neuralgia, superior laryngeal neuralgia, hyoid bone syndrome, acute calcific retropharyngeal tendinitis, temporal tendinitis, thyroid and cricoid cartilage syndromes, and mastoid process syndrome are summarized.

Carotidynia: an unusual pain in the neck

Described by Fay in 1927, carotidynia has not received much attention in the otolaryngology-head and neck surgery literature. This unusual entity is characterized by ipsilateral neck pain in the region of the carotid artery near its bifurcation. The differential diagnosis is extensive and includes thyroiditis, migraine headache, aneurysm of the carotid system, temporomandibular joint syndrome, giant cell arteritis, and head and neck neoplasms. A correct diagnosis is usually achieved by careful review of the history and physical examination. Laboratory studies are obtained primarily to exclude other causes. Successful treatment is most often effected with the use of nonsteroidal antiinflammatory drugs, although other treatment modalities may be needed. A series of 25 patients treated during the past 10 years is presented. The symptoms, physical findings, appropriate laboratory studies, and a treatment protocol for this uncommon entity are detailed.

Facial pain. 'Why does my face hurt, doctor?'

In addition to sinus and dental abnormalities and stress, several different neurologic conditions can cause facial pain. These include various neuroalgias (trigeminal, vagoglosso-pharyngeal, cranial), carotodynia, and optic neuritis. Pain characteristics and results of specific neurologic tests establish the diagnosis. While carbamazepine (Tegretol) is the treatment of choice in many of these conditions, other drugs may also be beneficial. If drug therapy fails to relieve the pain, specific surgical procedures may be warranted.

[Facial pain and neuralgias. Diagnosis and treatment.]

The first type of facial pain is of vascular origin. Cluster headache is described as well as its subgroups and carotidodynia. Two organic lesions of the arterial wall can also cause facial pain: dissection of the internal carotid artery and giant cell arteritis. Among the facial neuralgias, trigeminal neuralgia is the most frequent. Also, local lesions in the cranial nerves can cause facial pain, as well as organic processes of the upper cervical spine and of the occipitocervical transition. The characteristics of facial pain due to eye or ENT and dental lesions are described. So called atypical facial pain occurs quite frequently and mostly affects middle-aged women.