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Expert Opinion on Pharmacotherapy Apr 2005SUNCT (Shortlasting Unilateral Neuralgiform Headache attacks with Conjunctival injection and Tearing) is a syndrome characterised by shortlived (5-240 s), strictly... (Review)
Review
SUNCT (Shortlasting Unilateral Neuralgiform Headache attacks with Conjunctival injection and Tearing) is a syndrome characterised by shortlived (5-240 s), strictly unilateral, orbital/periorbital, moderate-to-severe pain attacks, accompanied by rapidly developing conjunctival injection and lacrimation. Most attacks are triggered by mechanical stimuli, but there are also spontaneous attacks. Symptomatic periods alternate with remissions in an unpredictable fashion. In active periods, the attacks predominate during daytime, with a frequency that ranges from < 1 attack/day to > 30 attacks/h SUNCT is mainly a primary disorder, but is sometimes associated with intracranial structural lesions (symptomatic SUNCT). SUNCT has been included in the group of trigeminal autonomic cephalalgias, which are thought to depend on the activation of the trigeminal system together with the disinhibition of a trigeminofacial autonomic reflex. According to a few reports, SUNCT patients may benefit from carbamazepine, lamotrigine, gabapentin, topiramate or various surgical procedures. However, well-designed clinical trials are required before these therapeutic options can be sufficiently validated.
Topics: Carbamazepine; Clinical Trials as Topic; Diagnosis, Differential; Humans; SUNCT Syndrome
PubMed: 15934885
DOI: 10.1517/14656566.6.4.591 -
CNS Drugs 2002Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT) is a syndrome predominant in males, with a mean age of onset... (Review)
Review
Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT) is a syndrome predominant in males, with a mean age of onset around 50 years. The attacks are strictly unilateral, generally with the pain persistently confined to the ocular/periocular area. Most attacks are moderate to severe in intensity and burning, stabbing or electrical in character. The mean duration of paroxysms is 1 minute, with a usual range of 10 to 120 seconds (total range 5 to 250 seconds). Prominent, ipsilateral conjunctival injection and lacrimation regularly accompany the attacks. Nasal stuffiness/rhinorrhoea are frequently noted. In addition, there is subclinical forehead sweating. During attacks, there is increased intraocular pressure on the symptomatic side and swelling of the eyelids. No changes in pupil diameter have been observed. Attacks can be triggered mostly from trigeminally innervated areas, but also from the extratrigeminal territory. There are also spontaneous attacks. An irregular temporal pattern is the rule, with symptomatic periods alternating with remissions in an unpredictable fashion. During active periods, the frequency of attacks may vary from <1 attack/day to >30 attacks/hour. The attacks predominate during the daytime, nocturnal attacks being seldom reported. A SUNCT-like picture has been described in some patients with either intra-axial or extra-axial posterior fossa lesions, mostly vascular disturbances/ malformations. In the vast majority of patients, however, aetiology and pathogenesis are unknown. In SUNCT syndrome, there is a lack of persistent, convincingly beneficial effect of drugs or anaesthetic blockades that are generally effective in cluster headache, chronic paroxysmal hemicrania, trigeminal neuralgia, idiopathic stabbing headache ('jabs and jolts syndrome'), and other headaches more faintly resembling SUNCT syndrome. Single reports have claimed that carbamazepine, lamotrigine, gabapentin, corticosteroids or surgical procedures may be of help. However, caution is recommended when assessing any therapy in a disorder such as SUNCT syndrome, in which the rather chaotic and unpredictable temporal pattern makes the assessment of any drug/therapeutic effect per se a particularly difficult matter.
Topics: Anesthetics; Anti-Inflammatory Agents; Anticonvulsants; Cluster Headache; Conjunctival Diseases; Diagnosis, Differential; Drug Resistance; Headache Disorders; Humans; Nerve Block; Oxygen Inhalation Therapy; Psychotropic Drugs; Sex Factors; Syndrome; Treatment Outcome; Vasoconstrictor Agents
PubMed: 12027784
DOI: 10.2165/00023210-200216060-00002 -
Annals of Indian Academy of Neurology 2022
PubMed: 36560988
DOI: 10.4103/aian.aian_219_22 -
Headache Apr 1997The clinical features of SUNCT syndrome have been reviewed in 21 patients. There were 17 men and 4 women, rendering a clear male preponderance (ratio of 4.25). The mean... (Review)
Review
The clinical features of SUNCT syndrome have been reviewed in 21 patients. There were 17 men and 4 women, rendering a clear male preponderance (ratio of 4.25). The mean age at onset was around 51 years. Attacks were experienced mostly in the orbital/periorbital area and always recurred on the same side, with an erratic temporal pattern and remissions of varying lengths. Most attacks were moderate to severe in intensity and burning, electrical, or stabbing in character. The attacks were regularly accompanied by prominent, ipsilateral, conjunctival injection; tearing; and rhinorrhea or nasal obstruction. There were many precipitating mechanisms. Exclusively spontaneous attacks were described in 3 patients. The usual duration of paroxysms ranged from 10 to 60 seconds, Whereas the longest duration varied from 60 to 300 seconds. The frequency of attacks during the symptomatic periods varied from less than 1 attack daily to more than 30 per hour. In the majority of patients, supplementary examinations failed to show any notable abnormality. However, 2 patients were documented to have a symptomatic form of SUNCT, with a vascular malformation in the ipsilateral cerebellopontine angle. A variety of drugs and local anesthetic blockades, inclusive of tic douloureux drugs, were tried, but a persistent, convincingly beneficial effect was generally lacking. SUNCT syndrome is in the differential diagnosis when encountering unilateral, orbital/periorbital headache syndromes.
Topics: Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Female; Headache; Humans; Male; Middle Aged; Orbit; Pain; Syndrome; Tears; Trigeminal Neuralgia
PubMed: 9150613
DOI: 10.1046/j.1526-4610.1997.3704195.x -
Clinical Neurology and Neurosurgery Mar 2018SUNCT like syndrome has been observed as a post zoster condition, as a syndrome associated with overt ophthalmic zoster after appearance of herpetic lesions and in... (Review)
Review
BACKGROUND
SUNCT like syndrome has been observed as a post zoster condition, as a syndrome associated with overt ophthalmic zoster after appearance of herpetic lesions and in varicella zoster virus meningoencephalitis without rash. However, SUNCT like syndrome fully consistent and congruent with the criteria of the ICHD immediately before onset of an ophthalmic-distribution zoster has not been reported.
CASE PRESENTATION
We report 73-year-old patient with a SUNCT like syndrome as the first presentation of an acute ophthalmic-distribution zoster. Symptomatic treatment was highly effective, after antiviral treatment with acyclovir no further medication was required.
CONCLUSIONS
SUNCT like syndrome can be the initial clinical presentation immediately preceding an acute ophthalmic-distribution zoster. This is congruent with previous observations of zoster - related SUNCT like syndromes with different temporal relationship to zoster. Zoster - related SUNCT like syndromes seem to respond well to symptomatic treatment. Clinicians should ask and look for history and signs of ophthalmic zoster in SUNCT like headaches.
Topics: Aged; Analgesics, Non-Narcotic; Antiviral Agents; Herpes Zoster Ophthalmicus; Humans; Male; SUNCT Syndrome
PubMed: 29408766
DOI: 10.1016/j.clineuro.2018.01.033 -
Frontiers in Neurology 2020Opalski syndrome is a rare variation of lateral medullary syndrome (LMS) accompanied by ipsilateral hemiparesis. Short-lasting unilateral neuralgiform headaches with...
Opalski syndrome is a rare variation of lateral medullary syndrome (LMS) accompanied by ipsilateral hemiparesis. Short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing (SUNCT) is a rare headache syndrome which belongs to the trigeminal autonomic cephalalgias. SUNCT syndrome has been previously described in association with LMS. We here describe a case of SUNCT syndrome with Opalski syndrome caused by dorsolateral medullary infarction.
PubMed: 32117015
DOI: 10.3389/fneur.2020.00052 -
The Medical Journal of Australia Jun 1995
Topics: Adult; Aged; Conjunctival Diseases; Ergotamine; Female; Headache; Humans; Male; Sumatriptan; Syndrome; Tears; Vasoconstrictor Agents
PubMed: 7603383
DOI: 10.5694/j.1326-5377.1995.tb126061.x -
Neurology India 2021Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with autonomic... (Review)
Review
BACKGROUND
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA) are rare and disabling primary headache disorders that are subtypes of Short-lasting unilateral neuralgiform headache attacks (SUNHA).
AIM
The aim of this narrative review was to provide a comprehensive update on headache phenotype, pathophysiology, and various treatment options available for SUNCT and SUNA.
METHODS
References for this review were identified by searches of articles published in the English language in PubMed between 1978 and October 2020 using "short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)", "short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA)", "short-lasting unilateral neuralgiform headache attacks (SUNHA)", "trigeminal autonomic cephalalgias" as keywords in various combinations.
RESULTS
Of a potential 1103 articles, seven case series describing clinical characteristics of SUNCT/SUNA patients were identified for this review. For symptomatic/secondary SUNCT/SUNA, 53 individual case reports, and one case series were reviewed. One placebo-controlled trial and 11 open-label case series that evaluated various medical and surgical treatments in SUNCT/SUNA were also reviewed. Available literature suggests that SUNCT and SUNA are subtypes of the same disorder characterized by severe side locked short duration headache with ipsilateral prominent cranial autonomic symptoms and signs. Pathophysiology may involve both peripheral and central mechanisms. Lamotrigine is the most effective preventive therapy while intravenous lidocaine is the most efficacious drug as transitional therapy for severe disabling attacks. Surgical options including microvascular decompression in those having neurovascular conflict, occipital nerve stimulation, and hypothalamic deep brain stimulation can be alternative treatment options for medically refractory patients.
Topics: Headache; Humans; Lamotrigine; Microvascular Decompression Surgery; SUNCT Syndrome; Trigeminal Autonomic Cephalalgias
PubMed: 34003160
DOI: 10.4103/0028-3886.315990 -
Functional Neurology 1992SUNCT is a recently described unilateral headache with frequently occurring, shortlasting pain attacks in the ocular area accompanied by ipsilateral conjunctival... (Review)
Review
SUNCT is a recently described unilateral headache with frequently occurring, shortlasting pain attacks in the ocular area accompanied by ipsilateral conjunctival injection, lacrimation, and (subclinical) forehead sweating. In some patients, attacks may be triggered by cutaneous stimuli. In this communication, SUNCT patients (n = 5) are compared with the considerable clinical series of trigeminal neuralgia in the literature (e.g. Harris, 1940, 1433 cases). In several respects (unilaterality, triggering, brevity and frequency of paroxysms), SUNCT shows similarity to trigeminal neuralgia. SUNCT seems to differ clearly from trigeminal neuralgia in other respects: sex distribution (SUNCT patients are often males), pain localization (SUNCT patients have the pain in the ocular area), the carbamazepine effect, presence of conjunctival injection, lacrimation, etc. SUNCT may accordingly altogether seem to be distinct from trigeminal neuralgia.
Topics: Carbamazepine; Diagnosis, Differential; Headache; Humans; Male; Sex Factors; Syndrome; Terminology as Topic; Trigeminal Neuralgia
PubMed: 1607124
DOI: No ID Found -
Pain Medicine (Malden, Mass.) Feb 2019
Topics: Adult; Cluster Headache; Humans; Male; SUNCT Syndrome
PubMed: 30107598
DOI: 10.1093/pm/pny161