Seconder paroxysmal hemicrania caused by mucocele

Abstract

Paroxysmal hemicrania (PH) is classified as a subgroup of trigeminal autonomic headaches among primary headaches. The pain is unilateral, located frequently at the orbital, supraorbital and/or temporal regions. It is sharp, severe, and these headaches tend to occur at least 5 times a day, which last for 2 – 30 minutes, accompanied by autonomic findings such as conjunctival injection, lacrimation, nasal congestion, nasal discharge, ptosis and orbital edema. Secondary PH is associated with tumor or vascular pathologies. Most frequently hypophyseal tumors were detected.In our case, there was a mucocele originating from the left ethmoidal sinus and compressing on the medial rectus muscle in the cranial MR examination of a patient admitted with clinical features of PH.In this case, it was seen that neuroimaging is mandatory in patients with TOB, in order to exclude secondary causes. Also, nociceptive impulses originating from surrounding tissues with the compression effect of the mucocele induce trigeminal autonomic reflex, supporting the hypothesis that autonomic symptoms and pain occur with hypothalamic and trigeminal connections.