Painful neuralgia of C2-3 followed by herpes zoster in the trigeminal nerve distribution (P2.316)

Objective: To report 3 cases with neuralgia at C2-3 dermatome followed by herpes zoster infection in the trigeminal nerve distribution. Background: Painful neuralgia of C2-3 is mostly paroxysmal stabbing or sharp pain of severe intensity within cervical nerve dermatomes. This pain syndrome could be diagnosed as either 4.7 Primary stabbing headache (PSH) or 13.4 Occipital neuralgia (ON) by third edition of International Classification of Headache Disorders (ICHD), depending on the associated symptoms and disease courses, if secondary causes are not identified. Design/Methods: We report 3 cases with neuralgia at C2-3 dermatome followed by herpes zoster infection in the trigeminal nerve distribution. Our cases had preceding stabbing pain of severe intensity before the development of vesicular skin lesion which is of usual findings. However, their pain was localized at cervical dermatome (C2-3) while herpes zoster was activated as skin lesion at the trigeminal nerve branches (V1, V2, V3 dermatome, respectively). Results: This referred pain, from trigeminal herpetic infection to cervical neuralgia, may be explained by the anatomical convergence of C1 to C3 spinal nerve afferents and trigeminal nerve afferents at the brainstem level. After administration of an anti-viral agent, valacyclovir, their skin lesions and neuralgic pain had gradually improved. Conclusions: In conclusion, possibility of following herpes zoster infection outside the pain dermatome is also to be considered, even when the stabbing headache fulfills either 4.7 PSH or 13.4 ON at initial presentation. Disclosure: Dr. Yoo has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Shin has nothing to disclose. Dr. Lee has nothing to disclose. Dr. SONG has nothing to disclose.