Clinical Syndrome
Charlin syndrome, also known as nasociliary neuralgia and Charlin-Sluder cephalgia, is an uncommon cause of head and face pain. As with most headache syndromes, the exact cause of the pain of Charlin syndrome is unknown. However, the pathogenesis of this uncommon cause of head and face pain is thought to be dysfunction of the nasociliary ganglion in a manner analogous to the dysfunction of the sphenopalatine ganglion thought to be the source of cluster headache. The pain of Charlin syndrome has a rapid onset to peak, with attacks lasting 45 to 60 minutes. In some patients, these attacks can be triggered by sensory stimulation of the affected areas. Although in many ways similar to cluster headache (e.g., retroorbital location of pain, profuse unilateral rhinorrhea, rapid onset to peak, and short duration of attacks), many dissimilarities also exist. In contrast to cluster headache, alcohol consumption does not appear to trigger attacks of Charlin syndrome and the seasonal and chronobiological patterns so characteristic of cluster headache do not seem to be a factor ( Table 5.1 ). Blockade of the sphenopalatine ganglion, which is so effective in the treatment of cluster headache, is of little value in the treatment of Charlin syndrome. Patients suffering from Charlin syndrome uniformly respond to daily nasociliary nerve blocks with local anesthetic, as described subsequently.
Comparison Factors | Cluster Headache | Charlin Syndrome |
---|---|---|
Ocular and retroorbital location | Yes | Yes |
Unilateral | Yes | Yes |
Rapid onset to peak | Yes | Yes |
Severe intensity | Yes | Yes |
Attacks occur in paroxysms | Yes | Yes |
Duration of attacks short | Yes | Yes |
Pain free between attacks | Yes | Yes |
Significant rhinorrhea during attacks | Yes | Yes |
Alcohol triggers attacks | Yes | No |
Tactile trigger areas | No | Yes |
Seasonal pattern of attacks | Yes | No |
Chronobiological pattern of attacks | Yes | No |
Significant eye inflammation | No | Yes |
Responds to sphenopalatine ganglion block | Yes | No |
Responds to nasociliary block | No | Yes |