Carotidynia

Excerpt

Carotidynia, also known as Fay syndrome or transient perivascular inflammation of the carotid artery (TIPIC) syndrome, is a very rare disorder presenting with unilateral neck and facial pain. Carotidynia is classified as an idiopathic neck pain syndrome and is associated with point tenderness over the bifurcation of the carotid artery. The pain may radiate to the ear or forehead. Symptoms are made worse by head movements, chewing, yawning, coughing, or swallowing. Increased pulsations are noted in the associated carotid artery. Carotidynia is most commonly unilateral; however, bilateral cases have been reported.

Patients report self-limited episodes of neck pain, with each episode lasting approximately 7 to 14 days. Most patients experience a relapse of episodes every 1 to 6 months. Diagnosis is primarily clinical, based on patient history and physical examination, with imaging such as neck ultrasound used to rule out other causes. While neurological deficits are generally absent, some cases have reported neurological events. Carotidynia is often confused with more serious conditions like carotid artery dissection or neoplasms, contributing to patient anxiety.

Treatment is usually supportive, involving rest, NSAIDs, and reassurance. In persistent cases, corticosteroids may be prescribed, while other medications, such as calcium channel blockers or selective serotonin reuptake inhibitors, have been explored. The condition typically resolves spontaneously, with follow-up imaging showing regression of vascular inflammation.