Charlin Syndrome

Key Words

Charlin’s syndrome, Charlin-Sluder syndrome, eye pain, facial pain, headache, nasociliary ganglion, nasociliary nerve block cluster headache, nasociliary neuralgia

ICD-10 CODE G50.0

Clinical Syndrome

Charlin syndrome, also known as nasociliary neuralgia and Charlin-Sluder cephalgia, is an uncommon cause of head and face pain. As with most headache syndromes, the exact cause of the pain of Charlin syndrome is unknown. However, the pathogenesis of this uncommon cause of head and face pain is thought to be dysfunction of the nasociliary ganglion in a manner analogous to the dysfunction of the sphenopalatine ganglion thought to be the source of cluster headache. The pain of Charlin syndrome has a rapid onset to peak, with attacks lasting 45 to 60 minutes. In some patients, these attacks can be triggered by sensory stimulation of the affected areas. Although in many ways similar to cluster headache (e.g., retroorbital location of pain, profuse unilateral rhinorrhea, rapid onset to peak, and short duration of attacks), many dissimilarities also exist. In contrast to cluster headache, alcohol consumption does not appear to trigger attacks of Charlin syndrome and the seasonal and chronobiological patterns so characteristic of cluster headache do not seem to be a factor ( Table 5.1 ). Blockade of the sphenopalatine ganglion, which is so effective in the treatment of cluster headache, is of little value in the treatment of Charlin syndrome. Patients suffering from Charlin syndrome uniformly respond to daily nasociliary nerve blocks with local anesthetic, as described subsequently.

Table 5.1

Comparison of Cluster Headache and Charlin Syndrome

Comparison Factors	Cluster Headache	Charlin Syndrome
Ocular and retroorbital location	Yes	Yes
Unilateral	Yes	Yes
Rapid onset to peak	Yes	Yes
Severe intensity	Yes	Yes
Attacks occur in paroxysms	Yes	Yes
Duration of attacks short	Yes	Yes
Pain free between attacks	Yes	Yes
Significant rhinorrhea during attacks	Yes	Yes
Alcohol triggers attacks	Yes	No
Tactile trigger areas	No	Yes
Seasonal pattern of attacks	Yes	No
Chronobiological pattern of attacks	Yes	No
Significant eye inflammation	No	Yes
Responds to sphenopalatine ganglion block	Yes	No
Responds to nasociliary block	No	Yes