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HEADACHES: TEMPORAL ARTERITIES

on March 11th, 2009 by admin

Connective tissue in the body consists of strands of tissue lying between and inside the organs. Like all other parts of the body, the connective tissue can go wrong, and there’s a group of conditions called the connective tissue disorders, in which the body becomes allergic to elements of its own connective tissue. As connective tissue is found in organs throughout the whole body, the inflammation this causes can be widespread. Fortunately, they are quite rare and only one of the connective tissue disorders – temporal arteritis – is a significant cause of headaches. It’s not a common disease, but it’s important as, untreated, it can cause blindness, almost overnight.

The temple is the area of your head roughly between and above the eye socket and the ear. Across each temple runs the temporal artery. In temporal arteritis, the connective tissue inside this artery becomes very inflamed. As a result, the artery becomes much more prominent and very tender to the touch; at the same time there may be a severe headache. You may lose weight, and feel generally unwell in a non-specific way. There is often generalised scalp tenderness, and your muscles may ache over the whole of your body. And, finally, some patients get severe aching in the jaw muscles, on chewing. This ache quickly disappears when they stop chewing, and returns when they start again.

The importance of temporal arteritis lies not in the headache, but because it’s not just the temporal artery that is affected. The single artery which supplies the eyeball, the ophthalmic artery can also become inflamed; when it does it swells up on the inside, and in doing so blocks itself off, reducing or cutting off the supply of blood to the eye. Unfortunately, the retina is very delicate. It can’t survive for long without a blood supply, and if its blood supply fails, blindness can result, overnight. It’s a worrying prospect; fortunately, the doctor can stop this happening, provided the diagnosis of temporal arteritis is made quickly and treatment with high dose steroids started immediately.

Temporal arteritis typically affects those over sixty. It’s not always an easy diagnosis to make; the symptoms are often vague, and could point to a number of potential causes. Clinically the most significant pointer is that the temporal arteries are prominent, and tender, though it’s not always easy to determine whether tenderness over the temples is due to tender arteries or underlying tender muscles, in spasm, as in a tension headache.

To clinch the diagnosis the doctor will take a blood sample and measure its ESR (Erythrocyte Sedimentation Rate). High ESRs occur in only a few types of illness -connective tissue disorders, cancers, rheumatoid arthritis and severe long-standing infections. For the doctor, pain in the side of the head, tender temporal arteries, and a high ESR confirm the diagnosis.

In the past, one of the ways of making the diagnosis was to take a small piece out of the temporal artery itself and look at it under the microscope. (Technically this is called taking a biopsy.) Interestingly, after this procedure some cases seemed to improve simply because the biopsy had been taken!

Over the years, temporal arteritis is sometimes a self-limiting disease; about a third of patients can eventually manage without their steroids, but it may take as long as seven years before steroids can safely be withdrawn. In two thirds of cases, it isn’t possible to withdraw steroids at all. However, just because the disease may eventually go away doesn’t reduce the need for steroid treatment while you’ve got it. If you don’t take the steroids you may become permanently blind, without warning, perhaps overnight.

Although steroids reduce the risk of blindness, giving them doesn’t seem to shorten the life cycle of the disease itself. Naturally the doctor will want to use as low a dose as possible, to reduce side effects. However, the dose mustn’t be brought too low or relapses can occur.

Again, untreated temporal arteritis can progress to blindness. Unfortunately, once you’ve gone blind from temporal arteritis, nothing can be done to bring back your sight. Once the supply of blood has been shut off to the retina, the retinal cells die. They can never grow again, or be replaced, even if the blood supply to the eye is restored.

Type of headache

The pain can be throbbing over the eye, or in the temple region – but the headache can just as easily be in the back of the head or neck. Locally, however, the temples arc often tender; so is the scalp

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