Abstract
The differential diagnosis of strictly unilateral hemicranial pain includes a large number of primary and secondary headaches and cranial neuropathies. It may arise from both intracranial and extracranial structures such as cranium, neck, vessels, eyes, ears, nose, sinuses, teeth, mouth, and the other facial or cervical structure. Available data suggest that about two-third patients with side-locked headache visiting neurology or headache clinics have primary headaches. Other one-third will have either secondary headaches or neuralgias. Many of these hemicranial pain syndromes have overlapping presentations. Primary headache disorders may spread to involve the face and / or neck. Even various intracranial and extracranial pathologies may have similar overlapping presentations. Patients may present to a variety of clinicians, including headache experts, dentists, otolaryngologists, ophthalmologist, psychiatrists, and physiotherapists. Unfortunately, there is not uniform approach for such patients and diagnostic ambiguity is frequently encountered in clinical practice.Herein, we review the differential diagnoses of side-locked headaches and provide an algorithm based approach for patients presenting with side-locked headaches. Side-locked headache is itself a red flag. So, the first priority should be to rule out secondary headaches. A comprehensive history and thorough examinations will help one to formulate an algorithm to rule out or confirm secondary side-locked headaches. The diagnoses of most secondary side-locked headaches are largely investigations dependent. Therefore, each suspected secondary headache should be subjected for appropriate investigations or referral. The diagnostic approach of primary side-locked headache starts once one rule out all the possible secondary headaches. We have discussed an algorithmic approach for both secondary and primary side-locked headaches.
Highlights
The location of pain is an important point to be considered while making a diagnosis of headache [1]
Making the correct diagnosis of side-locked headaches is very important for various reasons
We suggest that examination for provocative procedures should be done on each patient with side-locked headaches as many of these headaches may closely mimic primary headaches
Summary
The location of pain is an important point to be considered while making a diagnosis of headache [1]. Two-thirds of patients with cervical artery dissection may have a unilateral headache. A headache may be the initial symptoms in about half of the patients with cervical artery dissection [13]. Group −11 of ICHD-3β classification includes “Headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or the other facial or cervical structure”. One important subgroup in this is the headache related to ocular and orbital causes, and it may present as painful ophthalmoplegia. Headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure. Cervicogenic headache, glaucoma, ocular inflammatory disorder, trochleitis, disorder of the ears, rhinosinusitis, teeth or Jaw, temporomandibular disorder, inflammation of the stylohyoid ligament
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