Primary and Secondary Red Ear Syndrome: Implications for Treatment

Approximately 57 patients with red ear syndrome have been reported in the literature since it was initially described in 1994. The clinical phenotype therefore continues to be defined and no consistent treatment response has been described. We report three new cases of red ear syndrome and suggest that the disorder may exist as a primary trigeminal or cervical autonomic cephalalgia, coexist with other rare trigeminal autonomic cephalalgias, or may be secondary. The pathogenesis in these different circumstances may be distinct, the triggers specific and, when secondary, the disorder may be more resistant to treatment.

[Migraine with prolonged eyelid edema: a series of 10 cases]

INTRODUCTION

Migraine may present with cranial autonomic symptoms typical of trigeminal-autonomic cephalalgias, thus posing diagnostic difficulties. AIM. To report a series of patients with prominent eyelid oedema associated with migraine.

PATIENTS AND METHODS

Ten patients attending the headache offices in three hospitals (nine women, one man; age: 26-53 years-old) with recurrent eyelid oedema as a migraine accompaniment.

RESULTS

According to the diagnostic criteria of the International Classification of Headache Disorders (ICHD-III, beta version), eight patients had migraine without aura, one had migraine with aura, and one had chronic migraine. Eyelid oedema appeared during the most severe headache attacks, and had longer duration than the pain. Pharmacological or systemic causes of the oedema were ruled out in all cases. Other associated autonomic symptoms were conjunctival injection (n = 3), lacrimation (n = 2) and rhinorrhoea (n = 1). Both the pain and the oedema improved with symptomatic and preventive therapies for migraine.

CONCLUSIONS

Eyelid oedema may occasionally be a migraine accompaniment. It appears in some patients during their most severe migraine attacks, and may improve with the acute and preventive treatment for migraine.

Update on the diagnosis and management of Trigemino-Autonomic Headaches

Severe shortlasting headaches are rare but very disabling conditions with a major impact on the patients' quality of life. Following the IHS criteria, these headaches broadly divide themselves into those associated with autonomic symptoms, so called trigeminal autonomic cephalgias (TACs), and those with few autonomic symptoms. The trigeminal-autonomic cephalgias include cluster headache, paroxysmal hemicranias, and a syndrome called SUNCT (short lasting unilateral neuralgic cephalgias with conjunctival injection and tearing). In all of these syndromes, hemispheric head pain and cranial autonomic symptoms are prominent. The paroxysmal hemicranias have, unlike cluster headaches, a very robust response to indomethacin, leading to a notion of indomethacin-sensitive headaches. Although TACs are, in comparison with migraine, quite rare, it is nevertheless very important to consider the clinical factor that they are easy to diagnose and the treatment is very effective in most patients.