Ultrasonographic imaging of carotidynia: syndrome or entity?

In the past, carotidynia was regarded as a distinct syndrome of unilateral neck pain and tenderness of the carotid bifurcation without structural abnormality. At present, however, carotidynia is considered to be a misleading term for a nonvalidated entity. We performed ultrasonographic investigation in six consecutive cases that fulfilled clinical criteria of idiopathic carotidynia according to the former International Headache Society classification. In all patients, poor echoic wall thickening of the carotid bulb was found exactly in the region of tenderness, leading to mild lumen narrowing and large outward extension of the vessel. In some cases, manifestation of the ultrasound findings could be seen in two different layers of the vessel wall. On follow-up evaluation within 3-5 weeks, the wall thickening was significantly smaller. In two patients having MRI of the carotid bifurcation, there was no evidence of intramural hematoma. Our findings of similar ultrasonographic patterns in all patients suggest that carotidynia is a distinct entity possibly caused by inflammation. The findings correspond to recently published MRI and histological data.