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BRIEF COMMUNICATIONS: Julio Yangüela, Juan A. Pareja, Nicolas Lopez, and Margarita Sánchez del Río Trochleitis and migraine headache Neurology 2002; 58: 802-805 [Abstract] [Full text] [PDF]

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Reply to Letter to the Editor

Julio Yanguela   (25 February 2003)

Trochleitis and migraine headache

Lawrence Tychsen   (25 February 2003)

Reply to Letter to the Editor 25 February 2003
Julio Yanguela Fundacion Hospital Alcorcon Madrid Spain Send Correspondence to journal: Re: Reply to Letter to the Editor JYanguela{at}fhalcorcon.es Julio Yanguela	In our article on trochleitis and migraine headache, we included recent references but were limited in the number of references acceptable for brief reports. [1] Therefore, the early studies on inflammation of the superior oblique tendon/pulley, were not included. These papers comment on local corticosteroid treatment [2], tenderness in the trochlear region [3] and inflammatory findings on biopsy [4]. Tychsen´s paper is an excellent study and if he coined the term trochleitis, his reference might appropriately have been cited. However, our major point is that trochleitis, may trigger or sustain chronic migraine in some patients, a point not made in the above studies. References: 1- Yangüela J, Pareja, JA, Lopez, N, Sánchez del Río. Trochleitis and migraine headache. Neurology 2002;58:802-805. 2- Hermann JS. Adquired Brown´s Syndrome of inflammatory origin. Response to locally injected steroids. Arch Ophthalmol 1978; 96 :1228- 1232. 3- Sandford- Smith JH. Superior oblique tendon sheath syndrome. Brit.J. Ophthal. 1975;59:385-386.
Trochleitis and migraine headache 25 February 2003
Lawrence Tychsen Washington University Medical Center St. Louis MO Send Correspondence to journal: Re: Trochleitis and migraine headache stockstad{at}vision.wustl.edu Lawrence Tychsen	The article by Yanguela et al. reported that trochleitis can cause a worsening of ipsilateral headache (baseline migraine), and an effective treatment is peritrochlear injection of a combination of dexamethasone and methylprednisolone. [1] The authors' appear to have overlooked the initial report of trochleitis (1984) [2], which described 13 patients, examined and treated at the University of Iowa Hospitals. The 1984 report coined the term and enumerated the diagnostic criteria listed by these authors: 1) inflammation of the superior oblique tendon/trochlear pulley in the superonasal aspect of the anterior orbit, with 2) orbital pain and tenderness to palpation in that region and 3) often pain on vertical eye rotations (especially in adduction). The 1984 report also noted that ipsilateral headache often accompanied the orbital pain, and an effective treatment was peritrochlear injection of a combination of dexamethasone and methylprednisolone. References: 1- Yangüela J, Pareja, JA, Lopez, N, Sánchez del Río. Trochleitis and migraine headache. Neurology 2002;58:802-805. 2- Tychsen L, Tse DT, Ossoinig K, Anderson RL. Trochleitis with superior oblique myositis. Ophthalmology 1984;91:1075-1079.