There is a phenomenon known by lots of names. The name I most recently heard was “the red car effect.” It occurs when you are interested in a particular subject (like red cars) and suddenly you start seeing red cars everywhere. The truth is that red cars are around all the time. We just do not notice them much unless we have a particular interest in them.
Last week, I had a “red car” experience. It happened when I noticed that there was a painful lump in my neck that I thought was a swollen lymph node after a recent sore throat. However, I could feel my pulse in the lump, which made me realize that it was my carotid artery instead of a lymph node. It was actually a problem called carotidynia.
I only remember diagnosing carotidynia a few times over the many years of my medical career. When I asked other doctors, they also had not made this diagnosis many times. However, I saw a man in the ER with this problem just a couple days later. Carotidynia is my “red car.”
The medical literature states that carotidynia is a common neck pain syndrome first described by Temple Fay in 1927. The pain is typically dull, throbbing, continuous, and localized over the area high in the front of the neck where you can feel your pulse in the carotid artery. The pain may radiate to the jaw, cheek, eye, or ear on the same side.
Symptoms are frequently made worse by swallowing, chewing, and moving the head to the opposite side. The main physical sign is tenderness when the carotid artery is pressed. Sometimes, there is prominence or throbbing of the carotid pulse. Although several serious conditions should be excluded, most cases are not dangerous.
Severity varies from mild to agonizing. A history of migraine headaches may be present. In other cases, a history of previous sore throat, upper respiratory infection, oral conditions, or recent dental procedures is reported. Anxiety or fear of cancer is often present.
There are three main types of carotidynia, with classic carotidynia being the most common type. It usually attacks the patient under 60 years of age and usually is found in patients without any personal or family history of migraine. Some patients complain that they had a preceding illness like sore throat or upper respiratory infection or exposure to cold weather. Some classic carotidynia patients have complained of having swollen glands or the sensation of a foreign body in the throat. The patient may also have pain associated with nasal stuffiness and tearing in the eyes.
Migrainous carotidynia also attacks patients under 60 years of age. However, it is a chronic and/or recurrent illness. Many migrainous patients have a history of having been previously treated for migraine headaches.
Arteriosclerotic carotidynia is the rarest of the carotidynia varieties but its attacks can be very serious. It generally occurs to patients over 60 years of age. The patient may have a noise heard in the carotid artery in the neck called a bruit or there may be a palpable lump in the artery. Some patients report that they are unable to extend their head away from the affected side. They may even black out or feel extremely dizzy while their head is bowed down or angled towards the affected side.
Classic carotidynia, migrainous carotidynia, and arteriosclerotic carotidynia usually have the same physical exam. So the specific diagnosis is based more on the history.
Once other more dangerous problems have been ruled out and the diagnosis of carotidynia is made, the treatment is usually fairly simple. It generally involves anti-inflammatory medicines or migraine treatment or prevention drugs. However, arteriosclerotic carotidynia deserves more careful attention and treatment.
We do not really know how many patients develop carotidynia. But most authors agree that it is common but frequently unrecognized, just like those red cars.
Dr. Terry Gaff practiced family medicine in Albion for 17 years and is now medical director of the emergency department at Parkview Noble Hospital in Kendallville and the Noble County EMS. He welcomes your questions. He can be reached at firstname.lastname@example.org