Diagnosis and Treatment of Giant Cell Arteritis

Questions and Tests Your Doctor May Use

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A headache itself is not always a primary disorder, but rather a symptom of another underlying disease process. For example, in a health condition called giant cell arteritis (also known as temporal arteritis ) a headache is the most frequent initial complaint.

Definition of Giant Cell Arteritis

Giant cell arteritis or GCA is a large and medium blood vessel vasculitis, and the term "vasculitis" means that certain blood vessels in the body are inflamed.

GCA mostly affects the branches of the external carotid artery, a large artery in the neck. The inflammation of specific arteries in GCA impairs blood flow, causing various symptoms like a headache, vision changes, and jaw pain when chewing.

Diagnosing GCA

Obtaining a thorough medical history is critical to diagnosing GCA. This is why your doctor will specific questions before proceeding with further tests or treatment. Due to the fact that GCA rarely occurs in young individuals, your doctor will likely only probe into these specific questions if you are age 50 or older.

Some questions your doctor may ask include:

Is Your Headache New?

For most adults suffering from GCA, their headache is not only severe but new, meaning they have never felt this type of head pain before.

Where Is Your Headache?

Typically, the headache of GCA is located in the temples, but it can be more generalized or localized to the forehead or back of the head.

In addition, it may also occur on both sides of the head or on one side. With temple pain, people may complain of discomfort when putting on a hat or combing their hair.

Do You Have a Fever or Chills?

Your doctor will take your temperature, as fever is commonly seen in those with GCA, but not always.

How Do You Feel?

People with GCA tend to feel and look lousy. In addition to a headache, they may note weight loss, fatigue, a loss of appetite, and/or a cough.

Do You Have Any Aches?

A condition called polymyalgia rheumatic (PMR), which causes morning aches and stiffness in the hips, shoulders, and neck, has been associated with GCA.  So if you have been diagnosed with PMR and have a new headache, your doctor may put two and two together and suspect a diagnosis of GCA.

Does Your Jaw Hurt When Chewing?

This symptom is called jaw claudication and is seen in about one-half of people with GCA. The jaw pain is often felt near the temporomandibular joint (TMJ) and occurs after eating food that requires rigorous chewing, like red meat or a bagel.

Do You Have Any Vision Changes?

There are a number of visual changes that may occur in patients with GCA, with the most serious one being a complete loss of vision. This is why if a doctor suspects GCA, he will treat it right away to quickly control the inflammation and prevent blindness.

Treating GCA

If your doctor suspects GCA as the cause of your headache than she will likely order an erythrocyte sedimentation rate (ESR), which is a marker of body inflammation and is characteristically high in those with GCA.

You doctor will also likely refer you for a temporal artery biopsy to confirm the diagnosis. This means that a tiny tissue sample of your temporal artery will be removed so it can be examined under a microscope for signs of vasculitis.

Treatment of this disorder entails a long course of high dose glucocorticoids, like prednisone. Duration of therapy can range from several months to years, in order to prevent serious GCA-related complications, like irreversible vision loss. The challenging part of treating GCA with a high dose of oral steroids, for this duration, it that steroids may cause adverse effects like high blood pressure and blood sugars, infections, and bone fractures.

To reduce the dose and duration of glucocorticoid use in GCA, one small study in Arthritis Rheumatism examined the initial treatment of GCA with an intravenous glucocorticoid followed by oral glucocorticoid use. This successfully allowed for a lower dose and faster tapering down of the steroids, when compared to the people who took oral steroids without an initial intravenous dose.

Other doctors may consider the use of immunosuppressive therapies (for example, methotrexate or azathioprine) as an add-on medication to achieve a quicker remission so that a person is less likely to experience the adverse effects of long-term steroid use. That said, the scientific evidence on these therapies is still limited.

A Word From Verywell

Of course, if you have a new-onset headache or a change in headache pattern, see your healthcare provider for a proper diagnosis. There are lots of other health problems that could be going on, and the symptoms can mimic those of GCA.

That said, if you are diagnosed with GCA, know that it is a treatable disease, but it needs to be treated right away. As always, listen to your instincts and be proactive in your healthcare.

Sources:

Caylor TL, Perkins A. Recognition and management of polymyalgia rheumatica and giant cell arteritis. Am Fam Physician. 2013 Nov 15;88(10):676-84.

Ponte C, Rodrigues AF, O'Neill L, Luqmani RA. Giant cell arteritis: Current treatment and management. World J Clin Cases. 2015 Jun 16;3(6):484-94.

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