Headache and Temporal Arteritis: When to Suspect and How to Manage

• Published in: Current pain and headache reports Vol. 16; no. 4; pp. 371 - 378
• Main Author: Nahas, Stephanie J.
• Format: Journal Article
• Language: English
• Published: New York Current Science Inc 01-08-2012; Springer Nature B.V
• Subjects: Adrenal Cortex Hormones - therapeutic use; Autoimmune diseases; Biopsy; Diagnosis, Differential; Female; Giant Cell Arteritis - diagnosis; Giant Cell Arteritis - drug therapy; Giant Cell Arteritis - pathology; Headache - diagnosis; Headache - drug therapy; Headache - pathology; Humans; Inflammation Mediators - blood; Internal Medicine; Male; Medicine; Medicine & Public Health; Neurologic Examination; Pain Medicine; Risk Assessment; Risk Factors; Section editor; Temporal Arteries - pathology; Uncommon Headache Syndromes (ME Bigal; Vein & artery diseases; Headache; Secondary headache; Vasculitis; Treatment; Temporal artery biopsy; Temporal arteritis; Giant cell arteritis; Diagnosis
• ISSN: 1531-3433; 1534-3081
• DOI: 10.1007/s11916-012-0265-z

Temporal arteritis, also termed giant cell arteritis, is one of the vasculitides affecting large and medium sized cranial arteries, particularly of the carotid tree. Clinical manifestations may vary from the classic constellation of temporal headache in the elderly accompanied by constitutional signs, jaw claudication, and visual symptoms; therefore, a high index of clinical suspicion may be necessary to identify the disorder. Once suspected, immediate treatment is crucial while exploring any number of diagnostic tools to confirm or refute the diagnosis, since morbidity from untreated temporal arteritis can be devastating. At the same time, achieving a definitive diagnosis is paramount, as treatment can be toxic with significant morbidity of its own. Temporal artery biopsy remains the gold standard, but noninvasive diagnostic approaches are being refined. Corticosteroids remain the cornerstone of treatment, but are ineffective for, not tolerated by, or contraindicated in some individuals, necessitating the exploration of alternatives.