Page 341 - The Vasculitides, Volume 1: General Considerations and Systemic Vasculitis

Giant Cell Arteritis 315

Headache

Although headache is a prominent feature, it is not universal [46, 50-52]. Classically it
tends to be a constant ache of sudden onset in the temporal region and is usually severe
enough to disturb sleep [51, 53]. It can vary greatly in intensity and location, be constant or
intermittent, and assume virtually any form mimicking tension-type headache, thunderclap,
migraine and even cluster headaches [1]. It may become progressively worse, or wax and
wane, temporarily subsiding in the absence of treatment [54]. A key feature is that it typically
differs from any other previously experienced headache, and for this reason, the patient may
deny headache, instead calling the symptom head pain [55]. The headache may be associated
with scalp tenderness especially on hair brushing and combing or wearing glasses [47].
When severe, even the slightest pressure on resting the head on a pillow may be intolerable.
Pain is usually localized to one or both temporal regions, the forehead or occiput. However,
the pain may be generalized, spare the scalp altogether or affect the eye, ear; face, jaw or neck
[55]. Tenderness, prominence and decreased temporal artery pulsation (Figure 2) increase the
likelihood of GCA [46], although one-third of TAB-proven GCA patients have normal
temporal arteries on clinical examination.

Figure 2. Prominence of the temporal artery in GCA.

Jaw Claudication

Although the most specific feature of GCA, jaw claudication, or pain and fatigue in the
masseter muscles on protracted or vigorous chewing that eases with rest, is present only in
about one-half of patients, it can also have an abrupt trismus-like symptom [54] and remain
intermittent for weeks or months [55]. Jaw claudication should not be confused with temporo-
mandibular joint (TMJ), tooth or gum disease. Tongue claudication is less common.

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