Carotidynia

Epidemiology

Carotidynia is an idiopathic syndrome consisting of neck pain associated with tenderness to palpation over the region of the carotid bifurcation. There is no reported incidence or gender predilection, given that the mere existence of this “disease” is controversial. However, the trend is to consider carotidynia a diagnosis of exclusion that represents an idiopathic “organic” disease of the carotid artery. In general, the disease appears to involve patients between the third and sixth decade of life. To make the diagnosis in a patient with characteristic symptoms and findings, one must exclude other disorders that can give a similar presentation, including metastatic squamous cell carcinoma, lymphoma, giant cell arteritis, atherosclerosis, thrombosis, intraluminal hemorrhage, fibromuscular dysplasia, aneurysm, and dissection.

Pathology

No pathological studies of carotidynia have been performed due to the benign course of the disease and the risks associated with biopsy of the carotid. Carotidynia is thought to be inflammatory in nature and may involve the adventitial layer of the wall of the carotid artery.

Clinical Findings

The clinical diagnosis based on the International Headache Society (1988) criteria includes the following points:

1. At least one of the following overlying the carotid artery

a. Tenderness

b. Swelling

c. Increased pulsations

2. Appropriate investigations not revealing structural abnormality

3. Pain over the affected side of the neck; may project to the ipsilateral side of the head