Rare Headaches

Burning Mouth Syndrome

This is defined as a burning pain affecting the mouth or tongue, occurring daily for at least 2 hours a day, over more than 3 months, for which a medical or dental cause cannot be found. It tends to be chronic and disabling. It can affect up to 18% of postmenopausal women. The pain is described as burning, tender, tingling, hot, scalding, numbing, and the anterior tongue is the site most affected.

In two-thirds of patients, it is termed “primary,” meaning there is no defined cause. Possible causes in the other third include Sjögren’s syndrome, an autoimmune disorder; iron or zinc deficiency; badly fitting dentures; toothpaste that contains sodium lauryl sulfate; oral candidiasis; smoking; acid reflux; B12 deficiency; perhaps alcohol. Anxiety and depression are common in these patients.

They may also have a sensation that their mouth is dry even though the amount of saliva they make is normal. In Sjögren’s syndrome, the saliva production is indeed reduced. Some patients report that eating reduces pain.

Treatment is difficult, and studies are inconsistent. Most patients have tried antianxiety drugs, antidepressants, antiepileptic drugs, supplements. There are reports of topical clonazepam, a benzodiazepine, being helpful. Cognitive therapy may help as well. In one study, only 30% of patients responded to medications or spontaneously improved within 5 years of onset of symptoms.

Alice in Wonderland Syndrome

This was first described in 1952 by Dr Caro Lippman. His subjects were migraineurs who had an incorrect perception of body image and perceptual distortions of form, size, movement, color, and speed. They were aware that their perceptions were not real though children usually find them frightening. The symptoms in fact are more common in children and young adults. They are probably a “migraine equivalent,” as some of these children later on develop migraine with aura, years after the initial episodes. Infantile colic and childhood motion sicknesses can also be precursors of migraine.

The episodes usually last seconds to minutes, can occur preceding the headache or without a headache. The symptoms do not display the usual “march” of an aura over about 30 minutes.

Cold Stimulus Headache

This has been termed “ice cream headache.” It is frequent, obviously not disabling, as it is of short duration, and some people are susceptible. The pain, however, can be extremely intense. Cold stimulus headache sufferers seldom seek medical care. As the cause is obvious, they are able to prevent recurrences. The prevalence varies from 10% to 90% in some studies. A group of researchers attempted to trigger ice cream headache in 414 volunteers and found that 37% were susceptible.