Epicrania Fugax with Sagittal Trajectory of the Pain

Abstract

Dear Editor, Epicrania fugax (EF) was first described by Pareja et al in 2008 ⇓. It has been recently included in the Appendix of the 3rd edition of The International Classification of Headache Disorders (ICHD-III, beta version) ⇓. It is characterized by ultrabrief paroxysms of unilateral pain spreading from the posterior scalp to the ipsilateral eye or nose, along a linear or zigzag trajectory, and lasting less than 10 s. Pain intensity can be moderate or severe, and pain quality has been described as electric or stabbing. Autonomic symptoms can be present. Pain frequency is extremely variable and most attacks are spontaneous, but some of them can be provoked by tactile stimulation. Between paroxysms, mild pain or hyperesthesia could remain in the stemming area but complete disappearance of pain is also possible ⇓. As the first description of EF, there have been several publications supporting this new entity. A total of 66 cases have been reported up to now, 48 of them sharing the original forward radiation. Conversely, a backward radiation from frontal or periorbital areas toward the occipital region has been described in 18 cases ⇓. Pain paroxysms are strictly unilateral, although some patients have shifting sides ⇓. Associations with other headaches, mainly nummular …