Diagnosis and Management of Trochleodynia, Trochleitis, and Trochlear Headache

Conclusion Trochlear pain (trochleodynia) is becoming recognized as a set of disorders that can present in isolation or concomitantly with co-existing migraines, tension-type headaches, or other headache disorders, possibly explaining subpar symptom control in a small but significant number of individuals globally. Trochleodynia features unilateral periocular pain that may involve the ipsilateral hemicranium. Pain exacerbation occurs with trochlear palpation and supraduction of the affected eye especially in the adducted position. Trochleodynia may respond to oral NSAIDs if symptoms are mild and of recent onset. While oral NSAIDs may lead to remission with moderate to severe symptoms, the patient should be offered trochlear injection of corticosteroids. Bilateral manifestations could be concerning for an underlying systemic inflammatory disease, and workup could be considered (Table 1). Control of associated underlying disease almost always leads to trochleodynia remission. Nevertheless, in order to identify the optimal treatment paradigm for trochleodynia and better understand variations in response to treatment, prospective randomized control trials are required. Author Contributions All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. Conflict of Interest Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be constr...
Source: Frontiers in Neurology - Category: Neurology Source Type: research

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