11.3.4 Trochlear headache

Previously used terms:

Headache attributed to trochleitis.

A non-inflammatory disorder associated with trochlear dysfunction, termed primary trochlear headache, produces pain in the trochlear and temporoparietal regions that worsens with supraduction of the eye. It is diagnosed and treated similarly to trochleitis, and therefore included within 11.3.4 Trochlear headache.

Description:

Headache, usually frontal and/or periorbital in location, with or without eye pain, caused by peritrochlear inflammation or dysfunction. It is often exacerbated by movements of the eye.

Diagnostic criteria:
  1. Periorbital and/or frontal headache fulfilling criterion C
  2. Clinical and/or imaging evidence of trochlear inflammation or dysfunction including tenderness upon palpation of the trochlea in the superomedial orbit
  3. Evidence of causation demonstrated by at least two of the following:
    1. unilateral ocular pain
    2. headache is exacerbated by movements of the eye1
    3. headache is significantly improved by injection of local anaesthetic or steroid agent into the peritrochlear region
    4. headache is localized and ipsilateral to the implicated trochlea
  4. Not better accounted for by another ICHD-3 diagnosis.
Note:

Particularly vertical movements.

Comments:

Trochleitis, defined as inflammation of the trochlea and/or sheath of the superior oblique muscle, can lead to eye pain and frontal headache that are aggravated by movements of the eye involving the superior oblique muscle. While not common, it is not rare, and must be considered when evaluating unilateral periorbital head pain.

Trochleitis can also trigger an episode of migraine in patients with 1. Migraine, which should be coded according to its type or subtype.

11.3.4 Trochlear headache can be provoked by reading.