Which medication is associated with ciliochoroidal detachment?
The answer is B. Topiramate (Topamax) may cause idiosyncratic ciliochoroidal detachment and ciliary body edema, leading to anterior displacement of the lensiris diaphragm, lens thickening, and acute angle-closure glaucoma and acute myopia. These rare visual complications of topiramate typically occur while treatment is being initiated and are usually reversible with discontinuation of the medication. Gabapentin (Neurontin) is rarely associated with blurred vision and diplopia. Vigabatrin (Sabril) is associated with retinopathy with visual field defects. Carbamazepine (Tegretol) can cause nystagmus, diplopia, and blurred vision. Vigabatrin is associated with retinopathy with visual field constriction in up to 40% of patients; therefore, visual field testing is suggested with continued treatment with this medication. (Verrotti, Manco, Matricardi, et al., Pediatr Neurol 2007)
Cutaneous allodynia is most common in which headache type?
A. Transformed migraine
B. Severe episodic tension-type headache
C. Chronic daily headache
D. Probable migraine
E. Episodic migraine
The answer is A. The Allodynia Symptom Checklist (ASC) was used to measure allodynia, as well as headache features, disability, and comorbidities in over 16, 000 individuals who responded to a mail survey. Prevalence of CA was significantly higher in patients with transformed migraine (TM, 68.3%) than with episodic migraine (63.2%, p < 0.01). Cutaneous allodynia was reported less frequently in patients with probable migraine (42.6%), other CDHs (36.8%), and severe episodic tension-type headache (36.7%). Female gender, increased headache frequency, increased BMI, headache-related disability, and depression increased the prevalence of CA. (Bigal, Ashina, Burstein, et al., Neurology 2008)
A 50-year-old woman complained of continuous, moderate- to severe-intensity pain around her left ear, radiating to her temple, zygoma, and head of her mandible. She had tenderness in front of her left ear, and pressure in the area worsened the pain. She reported that she was able to eat and brush her teeth without significant exacerbation of her pain. She denied any autonomic symptoms associated with her pain. MRI studies of the brain and cervical spine were normal. What is the most likely diagnosis?
A. Auriculotemporal neuralgia
B. Trigeminal neuralgia
C. Cervicogenic headache
D. Hemicrania continua
E. Paroxysmal hemicrania
The answer is A. The auriculotemporal nerve is the terminal branch of the posterior division of the mandibular nerve (V3). Neuralgia of the auriculotemporal nerve produces moderate- to severe-intensity pain in the distribution of the nerve, which supplies sensation to the temporomandibular joint and external auditory meatus. The lack of autonomic symptoms distinguishes the neuralgia from hemicrania continua and paroxysmal hemicrania. The normal MRI of the cervical spine rules out cervicogenic headache. The relative lack of fleeting pain, triggered by stimulation, rules out trigeminal neuralgia. She had no autonomic symptoms characteristic of hemicrania continua or paroxysmal hemircrania. (Speciali & Goncalves, Curr Pain Headache Rep 2005)