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A difficult case
Trigeminal autonomic cephalgia caused by recurrent posterior scleritis
  1. Ali Alim-Marvasti1,
  2. Jason Ho2,
  3. Mark Weatherall1,
  4. Maneesh Patel3,
  5. Sheena George2,
  6. Stuart Viegas1
  1. 1Department of Neurology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
  2. 2Department of Ophthalmology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, Hillingdon, UK
  3. 3Department of Neuroradiology, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Stuart Viegas, Department of Neurology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; stuart.viegas{at}nhs.net

Abstract

A 40-year-old woman presented with a side-locked headache with autonomic features, which then switched sides before reverting to the original side. The atypical features of side swapping, partial response to indometacin and abnormal optic disc appearances ultimately led to a diagnosis of recurrent posterior scleritis. We discuss the differential diagnosis of trigeminal autonomic cephalgias and its secondary causes, and provide practical pointers for its investigation and management.

  • NEUROOPHTHALMOLOGY
  • HEADACHE
  • STEROIDS
  • NEURORADIOLOGY
  • OPHTHALMOLOGY

https://doi.org/10.1136/practneurol-2016-001433

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    Footnotes

    • Contributors AA-M wrote and edited the manuscript and performed literature review. JH wrote parts of the manuscript on scleritis, provided figure 1 and performed literature review. MW reviewed and edited manuscript and was involved in the care of the patient. MP provided MR images and descriptions for figure 2. SG was involved in the care of the patient and edited the manuscript section on scleritis. SV was the neurology consultant in charge of the care of the patient, was involved in writing and editing the manuscript and performed literature review.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Mark Lawden, Leicester, UK.

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