Abstract
A 55-year-old migrainous woman presents since the age of 11 with spontaneous outbursts of red burning ears lasting for about 30 min. Since last year, the episodes have occurred almost daily, despite the use of nortriptyline for migraine prophylaxis. No trigger factors are present. The neurological examination is normal, except for the ear redness (Figure 1). Brain and cervical MRI are unremarkable.
Red-ear syndrome is an under-diagnosed disorder of unknown aetiology and treatment (1) that may occur in association with migraine (2). It may be primary or secondary to various conditions including temporo-mandibular joint dysfunctions, upper cervical disorders, glossopharyngeal and trigeminal neuralgia (3). In our patient, the attacks happen independently from the migraine episodes (4). The rare simultaneous bilateral involvement challenges the hypothesis of an antidromic release of vasodilator peptides secondary to third cervical root discharges (5). It is possible that a brainstem dysfunction activates the trigeminovascular system bilaterally, leading to sensory antidromic and parasympathetic reflex firing.
Bilateral simultaneous red ears.