Headaches due to temporal arteritis

Pain associated with geant cell arteritis (GCA) is typically continuous, wi th exacerbations that often occur at night. Contact is painful and can prec ipitate an exacerbation of pain lasting several hours. The superficial temp oral artery is the most common target of GCA but symptoms vary according to the predominant site of arterial inflammation. As a result, GCA can presen t in different ways with headaches being mild or absent in some patients. i n nearly 40% of patients with biopsy-documented GCA, palpation of the branc hes of the external carotid artery fails to demonstrate any abnormalities. This arteritis affects the aortic arch and all its branches giving rise to a broad range of neurologic symptoms, for example, ocular disease, ischemic stroke, aortic dissection, etc. About 30 % of patients also have symptoms of polymyalgia rheumatica. Demonstration of an inflammatory syndrome is imp ortant and temporal artery biopsy is the last element of the diagnostic. in some locations of the GCA angiography is useful. Treatment, commonly inclu ding corticosteroids, should be initiated as early as possible. Prevention of osteoporosis should be initiated especially in elderly subjects. In some cases other treatments are useful anticoagulants, immunosuppressive therap ies, dapsone. (C) 2000 Editions scientifiques et medicales Elsevier SAS.