I. Pathophysiology

  1. Unknown etiology
  2. Extracranial carotid dilatation results in pain
    1. Face, ear or Neck Pain
    2. Headache (cervicogenic Headache)

II. Types

  1. Classic Carotidynia (Benign Carotidynia, Fay Syndrome)
    1. Most common type of Carotidynia
    2. More common in age under 60 years
    3. Associations
      1. Cold weather
      2. Preceeding viral illness
  2. Migrainous Carotidynia
    1. Migraine Headache variant
    2. More often in women under age 60 years
  3. Arteriosclerotic Carotidynia
    1. Occurs over age 60 years
    2. Results from Carotid Artery Stenosis
    3. Must be ruled-out in patients at risk

III. Symptoms

  1. Sore Throat
  2. Unilateral Neck Pain
    1. Ache or throbbing
    2. Moderate to severe
    3. May be constant or episodic
  3. Radiation
    1. Jaw, ear, or face on affected side
  4. Provocative
    1. Chewing
    2. Head movement
    3. Valsalva maneuver (yawn, cough, sneeze)
    4. Bending forward
  5. Associated symptoms with classic Carotidynia
    1. Malaise
    2. Nasal congestion
    3. Lacrimation

IV. Symptoms: Red Flags suggestive of arteriosclerosis

  1. Cardiac Risk Factors
  2. Difficulty extending neck away from affected side
  3. Near Syncope sensation on forward flexion of neck

V. Signs

  1. Tenderness to palpation
    1. Carotid Artery course
    2. Mouth floor at facial artery, submandibular Ganglion
  2. Absent clinical findings
    1. No distinct neck mass
    2. No fever
    3. No temperomandibular joint pain
  3. Findings suggestive of arteriosclerosis
    1. Carotid Bruit

VII. Evaluation

  1. Rule-out Carotid Artery Stenosis in patients at risk

VIII. Management

  1. Arteriosclerotic Carotidynia
    1. Treat as Carotid Artery Stenosis
  2. Classic Carotidynia
    1. Reassurance (Transient course)
    2. Local heat
    3. NSAIDs (e.g. Indomethacin 50 mg PO tid)
    4. Prednisone indicated for protracted course
      1. Dose: 40 mg PO qd tapered over 7-10 days
  3. Migrainous Carotidynia
    1. Consider Migraine Abortive Treatment (eg. Ergotamine)
    2. Consider Migraine Prophylaxis (e.g. Inderal, Elavil)

Images: Related links to external sites (from Google)

Ontology: Carotidynia (C0238902)

Concepts Disease or Syndrome (T047)
SnomedCT 21615003, 230482003
English CAROTID ARTERY TENDERNESS, CAROTODYNIA, tenderness of carotid artery (physical finding), tenderness of carotid artery, carotidynia, carotodynia, Autonomic facial cephalgia, Carotidynia, Carotodynia, Carotidynia (disorder), Autonomic facial cephalgia (disorder)
Italian Carotidinia
French Carotodynie, Carotidynie
Spanish Carotodinia, carotidinia (trastorno), carotidinia, carotodinia, cefalalgia facial autonómica (trastorno), cefalalgia facial autonómica, Carotidinia
Japanese 頚動脈圧痛, ケイドウミャクアッツウ
Czech Karotikodynie
Hungarian Carotodynia, Carotidynia
Portuguese Carotidinia
Dutch gevoelige arteria carotis
German Karotidenschmerz