Carotidynia, also known as Fay syndrome, is a rare syndrome characterised by neck pain in the region of the carotid bifurcation.
There is confusion in the literature as to what this term actually refers to, with some authors suggesting that the term should be reserved for a pain syndrome with no structural abnormality, whilst others contend that it is a defined inflammatory condition of the carotid. The latter use seems to be more useful as it correlates to a specific syndrome with defined imaging features (thickening and inflammation around the carotid bifurcation) and prognosis (spontaneous resolution in 1-2 weeks). It has been classified by the International Headache Society (IHS) in 1988 as an idiopathic neck pain syndrome associated with tenderness over the carotid bifurcation without structural abnormality.
Patients with carotidynia present with unilateral neck pain in the region of the carotid bifurcation 1. The pain typically tends to be dull and throbbing in nature, continuous, and usually localised over the carotid bifurcation, although may radiate to the ipsilateral mandibular, cheek, ocular, or auricular regions.
The aetiology of carotidynia remains unclear, however, it appears to be an inflammatory process involving the carotid wall, including the adventitia 1.
Carotidynia may be divided into three distinct classifications 10:
- non-migrainous (or classic) and
May inflammatory markers tend to be elevated which include 4:
- C-reactive protein (CRP)
- erythrocyte sedimentation rapidity (ESR)
- serum amyloid A (SAA) protein
- fibrin degradation product / D-dimer
Contrary to diagnostic criteria proposed by the Headache Classification Subcommittee of the IHS 3, which suggests carotid structural abnormality should be absent, relatively consistent imaging findings are encountered 1-2.
Regardless of modality (ultrasound, CT, MRI) typical features of carotidynia include 1-2:
- region: distal common carotid artery, bulb and proximal internal carotid artery
- lumen: mild luminal narrowing
- concentric thickening of the carotid wall
- enhancement (CT and especially MRI)
- transient fatty plaque during healing 1
- surrounding soft tissues: fat stranding
Treatment and prognosis
Carotidynia is usually self-limiting, spontaneously resolving within 2 weeks. Resolution can be expedited with non-steroidal anti-inflammatory drugs or steroids 1.
History and etymology
It was first described by Temple Fay in 1927 7.
The differential includes other vascular causes of neck pain, including 1:
- arterial dissection
- large vessel vasculitides
- jugular vein thrombosis
Other wider clinical differential considerations include 2:
- cervical lymphadenitis
- submandibular gland diseases
- head and neck tumours
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