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Carotidynia: Does This Cause Dangerous Headaches?

Carotidynia may or may not be the cause of dangerous headaches. First of all the term "carotidynia" refers to pain in the carotid arteries, which are located on either side of the neck.

When this type of pain does occur, it may refer up to the head and therefore is called a secondary headache. This is because some other medical problem is causing the headache.

The pain may also occur deep inside the ears and can be very severe, due to the fact that there is a branch of the carotids runs right behind the ear. It can also radiate to the jaw and behind the eye. The pain is aggrevated by moving the neck, coughing, yawning or sneezing.

This type of pain can be a form of vasospasm of the arteries, but it can also involve inflammation of the artery.

Carotidynia vs Other Headaches

This type of head pain is not like a tension headache in that it is not just a throbbing headache. Once the pain occurs it may wax and wane a bit but as mentioned it is quite painful. Other cases can be mild. I should mention that most of the tijme when carotidynia occurs, it is unilateral or on one side only.

Certain things put people at risk for getting carotidyna. These include:

  • smoking resulting in carotid stenosis (plaque formation in artery)
  • previous history of headaches, including migraines
  • recent upper respiratory infection
  • recent dental procedures
In the presence of one sided neck pain, certain other conditions should be considered. These might include:
  • dental disease
  • TMJ syndrome
  • peritonsilar abcess
  • thyroiditis
  • tumor of the tongue or throat
  • lymphadenitis
  • cervical dystonia (muscle spasm)
  • carotid dissection
  • carotid aneurysm

Association With Migraine

There is a strong association with this type of pain and migraine. The final result of a migraine afterall is vasospasm. There are reports of patients having episodic carotidynia for years, the same as migraine. When recurrant like this, it may respond to the medications used to prevent migraine such as tri-cyclic anti-depressants, beta-blockers and calcium channel blockers. The later is probably the best choice to start with.

Side effects of TCA's include sedation so it is taken at night. It may also cause nightmares at first and can cause urinary retention and urinary frequency. Beta blockers and calcium channel blockers are in the anti-hypertensive class and as such have the potential to cause light headedness, constipation and decreased exercise tolerance in the case of the beta blockers. Beta blockers also rarely can cause hair loss and erectile dysfunction.

Non migrainosus carotidynia is usually seen in people over the age of 60 who have some history of atherosclerosis. The plaque formation from years of high cholesterol can lead to narrowing of the arteries called carotid stenosis. The International Headache Society lists carotidynia as a "headache attributable to a cranial or cervical vascular disorder".

Diagnostic Studies

After a thorough exam, your physician may order some studies. The first should be an MRA of the carotids to rule out aneurysm or dissection, and perhaps an MRA of the arteries in the brain. Some might consider a doppler of the carotids, but an MRA is best. This is a non-invasive study similar to an MRI but looks only at the arterial system.

Further studies might include a sonogram of the thyroid, and perhaps a laryngoscopy. Blood work should include an ESR and sed rate to look for excessive inflammation.

Treatment

Treatment is simple once the diagnosis is made. As mentioned, if recurrant daily medication should be considered. If a new episode, generally these cases respond to an anti-inflammatory taken for a few days. If a recurrent case, as noted above, prophylactic medication should be taken for several weeks to a few months.

Doesn't sound like you?? Ok then read more about different types of headaches to see what kind of headache you might have.

References:

International Headache Society. Classification of Headaches. Obtained online from http://ihs-classification.org/en/02_klassifikation/05_anhang/06.05.06_anhang.html

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