• María Gutiérrez-Sánchez, David García-Azorín, Álvaro Gutiérrez-Viedma, Nuria González-García, Alejandro Horga, Susana Martín, Ángel L Guerrero, and María-Luz Cuadrado.
• Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
• Cephalalgia. 2020 Aug 1; 40 (9): 959-965.

BackgroundEpicrania fugax consists of brief paroxysms of pain, which radiate in a line or in zigzag trajectory across the surface of the scalp or the face.MethodsA prospective, descriptive study was performed in five patients presenting with an epicrania fugax-type pain with extracephalic irradiation.ResultsAll patients were women, and the mean age at onset was 59.8 (standard deviation, 10.9). They had unilateral paroxysms of electrical pain starting at a particular point in the head (parietal, n = 3; vertex, n = 1; frontal, n = 1) and rapidly radiating downwards in a lineal trajectory to reach extracephalic regions (ipsilateral limbs, n = 2; shoulder, n = 2; low neck, n = 1) in 1-3 seconds. Pain intensity was moderate or severe. Three patients had nummular headache at the point where the paroxysms originated. One patient had spontaneous remission, and four patients achieved complete or almost complete response with therapy (onabotulinumtoxinA, n = 2; indomethacin, n = 1; amitriptyline, n = 1; lamotrigine, n = 1).ConclusionThe spectrum of epicrania fugax may include paroxysms with extracephalic irradiation. The propagation of pain beyond the head and the face supports the involvement of central mechanisms in the pathophysiology of this entity.

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