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Carotidynia, or Fay syndrome, is a medical condition that has received a lot of attention over the years. Even now, it is unclear if this is in fact just an unusual presentation of a typical migraine case or if there is a specific pathological condition not explained by any other disease. 

This is a disease that is associated with atypical neuralgia attacks in the neck and face. In non-medical lingo, this means that you will have lightning-like pain shooting into your neck and head at any time with this disease.  Patients will also experience tenderness over the bifurcation of the carotid artery without any noticeable structural abnormality. When unexplained things happen around the head or the neck, physicians are quick to write it off as a migraine attack because migraines can present in thousands of different ways. Because of this uncertainty, the doctors are able to prescribe prophylactic and abortive medications to stop this "migraine." 

Although the physical presentation of carotidynia may make it hard to define it as its own separate disease, imaging studies show that that is exactly what it could be. MRI studies show that there is an abnormal thickening of tissue around the carotid arteries in patients that experience carotidynia that is not seen in a standard migraine attack. [1]

This condition, unfortunately, also has a number of different complications that are much more severe than a standard migraine headache. Studies show that when patients present with carotidynia, this could be a precursor for more severe conditions. In one study, 7 patients suffering from carotidynia were followed to determine long-term complications. Of the 7, 2 patients developed a dissecting aneurysm of the internal carotid artery, 2 developed significant clots, and 2 developed an incomplete vessel obstruction of the internal carotid artery. These are all red flag symptoms that can easily lead to strokes and other neurological conditions so it is paramount that you treat the condition as quickly as possible

Patients often first have a viral infection prior to pain localized to the neck. They may have a family history where a parent had similar symptoms but no genetic link has been confirmed. These symptoms can also be triggered by rapid changes in the weather, coldness or a history of prolonged smoking. 

When it comes time to diagnose your illness, this is a disease that will often be a secondary or tertiary option after more common diseases are ruled out like migraines and trigeminal neuralgia. Physicians must rule out more serious diseases like giant cell arteritis and will need to perform a biopsy in order to make sure everything appears normal. Depending on your ages, a carotid Doppler study of your neck will also be done to make sure that there are no occlusions or other red flag symptoms of an impending stroke. 

In most cases, carotidynia will be self-limited without medical intervention necessary but if symptoms become too overpowering, treatment options are available. It is common to use some type of steroid therapy to help limit the inflammation around the tissue. Various anti-migraine medications are also helpful at delaying potential outbreaks. Medications like Indomethicin are useful in dealing with the intense pain that can also occur. 

It is important to have consultations with a laryngologist, cardiologist, and neurologist to ensure that if you have these symptoms, the underlying cause is not something sinister. 

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