ABSTRACT
Ten patients (one man and nine women, mean age 48.8 +/- 20.1) presented with a stereotypical and undescribed type of head pain. They complained of strictly unilateral, shooting pain paroxysms starting in a focal area of the posterior parietal or temporal region and rapidly spreading forward to the ipsilateral eye (n = 7) or nose (n = 3) along a lineal or zigzag trajectory, the complete sequence lasting 1-10 s. Two patients had ipsilateral lacrimation, and one had rhinorrhoea at the end of the attacks. The attacks could be either spontaneous or triggered by touch on the stemming area (n = 2), which could otherwise remain tender or slightly painful between the paroxysms (n = 5). The frequency ranged from two attacks per month to countless attacks per day, and the temporal pattern was either remitting (n = 5) or chronic (n = 5). This clinical picture might be a variant of an established headache or represent a novel syndrome.
Subject(s)
Facial Pain/classification , Facial Pain/diagnosis , Headache/classification , Headache/diagnosis , Acute Disease , Adult , Aged , Facial Pain/pathology , Female , Headache/pathology , Humans , Male , Middle Aged , Pain/classification , Pain/diagnosis , Pain/pathologyABSTRACT
Nummular headache (NH) is a primary disorder characterized by chronic pain that is exclusively felt in a small area of the head surface. We describe five patients with circumscribed head pain and sensory dysfunction consistent with NH, who in addition developed colocalized trophic changes. All of them had a round or oval patch of skin depression (1-2 cm in diameter) inside of the painful area (2-4.5 cm in diameter). Three of them also showed hair loss, reddish colour, and local increased temperature. Skin biopsies were performed in three patients, and were not specific for any particular dermatological disease. Local trophic changes may be a clinical feature of NH. Together with pain and sensory disturbances, they could represent a restricted form of complex regional pain syndrome. This should be taken as a possible evolution of the underlying morbid process of NH.
Subject(s)
Body Temperature , Erythema/etiology , Hair/pathology , Headache/pathology , Headache/physiopathology , Sensation Disorders/etiology , Adult , Complex Regional Pain Syndromes/classification , Female , Headache/classification , Headache/complications , Humans , Male , Middle AgedSubject(s)
Allergens/adverse effects , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Occupational/diagnosis , Hand Dermatoses/diagnosis , Rhodium/adverse effects , Dermatitis, Allergic Contact/etiology , Dermatitis, Occupational/etiology , Diagnosis, Differential , Female , Hand Dermatoses/chemically induced , Humans , Middle Aged , Patch TestsSubject(s)
Forearm , Hyperhidrosis/diagnosis , Adolescent , Biopsy , Humans , Hyperhidrosis/pathology , Male , Recurrence , Skin/pathologyABSTRACT
Carbamazepine is a widely used drug associated with numerous side effects including skin eruptions that appear in about 4% of patients. Epicutaneous tests have been used with variable success in skin drug reactions. The purpose of this study was to work out the efficacy of this type of test in carbamazepine reactions. Five patients with carbamazepine cutaneous reaction were studied. Clinical, laboratory and histopathological data were recorded. The 5 patients and 20 controls were tested with carbamazepine 1% in petrolatum. In 4 patients the carbamazepine epicutaneous test was positive. The 20 healthy controls were negative. Epicutaneous testing is a simple and helpful method in detecting carbamazepine hypersensitivity.
