Carotid tenderness: an ominous sign of giant cell arteritis?

Giant cell (temporal) arteritis is a systemic vasculitis involving medium and large-sized vessels. Despite the high frequency of involvement of cranial arteries, pain on examination of the external carotid artery itself has been exceptionally reported. We describe 3 patients with biopsy-proven giant cell arteritis (GCA) and wincing pain on palpation over the external carotid. The presence of this sign may be a harbinger of the existence of severe vascular involvement in patients with GCA.