Primary trochlear headache: A new cephalgia generated and modulated on the trochlear region

ome patient complain of periorbital pain, emanating from the trochlear area, in abence of trochleiti or other orbital or ytemic dieae. In thee patient, adequate pain control may require local treatment rather than ytemically adminitered medication. The goal of thi tudy wa to evaluate the role of the trochlear area in cauing and modulating headache. Trochlear pain wa defined a pain on thi area, exacerbated upon examination and looking in upraduction. Pain wa evaluated after trochlear injection of lidocaine, corticoteroid, and placebo. econdary orbital pain wa ruled out. eventeen women and one man were evaluated (mean age: 44 year). All preented unilateral pain in the trochlear area (60% reported more extended headache), for more than 1 year in 70%. Neither ocular autonomic ign nor motility retriction were oberved. Imaging tudie were normal in 100%. The temporal pattern wa either chronic or remitting, with acute exacerbation. Pain increaed at night in 55%. A total of 62% preented concurrent headache. Locally injected corticoteroid relieved the pain within 48 hour in 95% and alo improved concurrent headache, by decreaing attack frequency and analgeic intake. Placebo wa not helpful. Relape were oberved in 45% (average 8 month). The author conclude that the trochlear region i the origin of a pecific and unrecognized headache, which they have named “primary trochlear headache”. Local treatment at the level of the trochlear area eem to be helpful.—Valerie Bioue