Epicrania fugax in a patient with an arachnoid cyst in Meckel’s cave

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IntroductionAlthough epicrania fugax is classified as a primary headache disorder, some cases associated with intracranial and extracranial lesions have been reported.MethodsCase report.ResultsA 45-year-old woman presented with a three-year history of headache, which she described as a severe stabbing pain, radiating from the right temporal region to the left temporal region, lasting approximately two seconds and occurring once per week. After one month, she also developed an additional headache described as a blade cutting the skin, of severe intensity, radiating along a zigzag trajectory from the left posterolateral cervical region to the left parietal area, occasionally crossing the midline, lasting 8 to 10 seconds. This occurred every two days, at times in clusters, and was not associated with autonomic symptoms. A brain MRI revealed a 2.4×1.9 cm lobulated extra-axial cystic lesion without contrast enhancement, closely related to the left Meckel’s cave, suggestive of an arachnoid cyst.ConclusionThis case underscores the need to investigate epicrania fugax using brain MRI to rule out secondary causes.

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