By Thomas N. Ward, M.D. Dartmouth Hitchcock Medical Center Lebanon, NH THE CASE A 67-year-old man came to a neurologist's office as a referral from a local family practitioner. The patient's doctor was concerned, as the patient had complained of a new headache. The headache had been present for three weeks, was mild to moderate in severity, and worse on the right side than on the left. There was no nausea, nor sensitivity to light or to sound. The patient reported some aching in his jaw and in his tongue during meals, which was a new symptom as well. Ominously, over the last week, he had experienced three 15-minute painless episodes of visual loss in his right eye. The patient reported that he had suffered from migraines in earlier years, but they were not at all like the current headache and he had not had any for many years. Over the past three months he had lost about 20 pounds though he wasn't dieting. He had felt generally mildly ill during this time frame and had mild discomfort in his shoulders and hips. Upon hearing this tale, the neurologist became quite animated. He examined the patient and spent some time palpating (feeling) the man's temples. He then sent the patient to the laboratory for blood testing and on to Radiology for a CT scan of the brain. The man was immediately started on a new medication and, when the CT scan report returned normal, a biopsy of one of the temperol arteries was performed. The headache resolved immediately. The medication controlled his symptoms. Over time, the medication was tapered, and then slowly discontinued.

Giant Cell Arteritis (previously known as Temporal Arteritis) is a vascular disease characterized by inflammation of blood vessels. It can cause a very severe headache that usually strikes people over age 55. The pain is in the temple, and vessels in that area can be tender. In some cases, patients may have other bodily symptoms such as fever, loss of appetite or joint and muscle pain. This is sometimes called Polymyalgia Rheumatica.