Abstract
BackgroundLinear headache (LH) has recently been described as a paroxysmal or continuous head pain restricted in a linear trajectory of 5–10 mm in width, linking one endpoint in occipital or occipitocervical region with another endpoint in ipsilateral nasion or forehead region. The sagittal line-shaped pain area of LH is close and parallel to a sagittal venous sinus, the superior sagittal sinus (SSS). For some patients, the LH had some features resembling the pattern of migraine without aura.Case descriptionA 45 year-old woman complained with a distinct headache for more than half years. The pain trajectory of the headache is confined to a coronal line-shaped area of 5–10 mm in width linking the two points in the bilateral temporal regions with the occipital protuberance. This coronal line-shaped pain area is close and parallel to a coronal cambered venous sinus complex, the combination of the confluences of sinus and the bilateral cavernous sinus (CS), superior petrosal sinus (SPS) linking the CS with transverse sinus (TS) and TS into which the SPS feeds. The patient had a past history of migraine without aura for 10 years and her son had a benign paroxysmal vertigo (BPV) for 12 years. Both of her coronal line-shaped headache and her son’s vertigo had well response to sodium valproate.Discussion and evaluationIts clinical characteristics were distinctly different from those of other two headache entities defined with topographical criteria, nummular headache and epicrania fugax, and different from other existing headache entities except for migraine without aura.ConclusionThe distinct coronal line-shaped headache is suggestive of a variant of LH, a coronal LH, and probably belongs to a subtype of migraine without aura as proposed for LH. This coronal LH reinforces the proposal of LH as a new headache syndrome or a subtype of a previously known headache syndrome, probably of migraine.
Highlights
Discussion and evaluationIts clinical characteristics were distinctly different from those of other two headache entities defined with topographical criteria, nummular headache and epicrania fugax, and different from other exist‐ ing headache entities except for migraine without aura
Linear headache (LH) has recently been described as a paroxysmal or continuous head pain restricted in a linear trajectory of 5–10 mm in width, linking one endpoint in occipital or occipitocervical region with another endpoint in ipsilateral nasion or forehead region
These two types of head pain both have a sagittal linear pain trajectory, here we report a distinct patient presenting with a recurrent head pain restricted in a coronal linear trajectory and had couple of features similar to that of LH
Summary
We report a patient presenting with a previously undescribed headache, a paroxysmal head pain restricted in a coronal linear trajectory, 5–10 mm in width, linking the two points in the bilateral temporal regions and the occipital protuberance. The current coronal line-shaped head pain is significantly different from ATNa. Except for the direction of the pain trajectory, all other features of the head pain in this woman are consistent with those of the previously reported LH in some patients, including the line-shaped pain area innervated by different nerves and the migrainous features of pulsating pain character, triggering or facilitating factor of anxiety, accompaniments of dizziness, head heaviness, and photophobia and phonophobia (Wang et al 2014a). Except for the direction of the pain trajectory, all other features of the head pain in this woman are consistent with those of the previously reported LH in some patients, including the line-shaped pain area innervated by different nerves and the migrainous features of pulsating pain character, triggering or facilitating factor of anxiety, accompaniments of dizziness, head heaviness, and photophobia and phonophobia (Wang et al 2014a) This coronal line-shaped headache is suggestive of coronal LH. This hypothesis is seemly supported by its positive response to sodium valproate which had been shown able to suppress CSD (Ayata et al 2006), her past history of migraine and her son’s BPV associated with migraine
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