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Cephalalgia : An International Journal... Jan 2021Trigeminal autonomic cephalalgias (TACs) are characterized by paroxysmal attacks of unilateral primary headaches associated with ipsilateral craniofacial autonomic... (Review)
Review
INTRODUCTION
Trigeminal autonomic cephalalgias (TACs) are characterized by paroxysmal attacks of unilateral primary headaches associated with ipsilateral craniofacial autonomic symptoms. In this pediatric case series, 13 cases of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA), including children ages 3-18 years, are discussed. This paper reviews the application of International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria especially in children presenting with SUNCT or SUNA. This is the largest pediatric case series of SUNCT/SUNA reported in the literature.
BACKGROUND
Trigeminal autonomic cephalalgias are rare in children and adolescents, with SUNCT/SUNA having the least reported cases. We will discuss the application of ICHD-3 criteria to diagnose SUNCT/SUNA in children and review overlapping cases and their response to different treatment options including indomethacin, which is typically reserved for specific subtypes of TACs; for example, paroxysmal hemicrania.
CONCLUSION
This case series presents a unique opportunity to aid in the diagnosis and treatment of similar pediatric cases in the future. It helps us to broaden the ICHD-3 criteria to diagnose and treat different overlapping trigeminal autonomic cephalalgia cases in children.
Topics: Adolescent; Child; Child, Preschool; Headache; Headache Disorders; Humans; Paroxysmal Hemicrania; SUNCT Syndrome; Trigeminal Autonomic Cephalalgias
PubMed: 32867532
DOI: 10.1177/0333102420954525 -
Cephalalgia : An International Journal... Jan 2021Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare but severely disabling variant within the spectrum of...
Refractory short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing responsive to anti-calcitonin gene-related peptide monoclonal antibodies: A case report.
BACKGROUND
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare but severely disabling variant within the spectrum of trigeminal autonomic cephalalgia lacking evidence-based treatment.
CASE
We report a case of chronic SUNCT in a 67-year-old man refractory to various guideline-conforming treatment attempts responding excellently to galcanezumab.
CONCLUSIONS
This case report indicates that monoclonal antibodies against calcitonin gene-related peptide, specifically galcanezumab, might be a treatment option for SUNCT warranting further investigation.
Topics: Aged; Antibodies, Monoclonal; Calcitonin Gene-Related Peptide; Headache; Headache Disorders; Humans; Male; Neuralgia; SUNCT Syndrome
PubMed: 32867531
DOI: 10.1177/0333102420954558 -
Neurological Sciences : Official... Dec 2020Cluster headache (CH), paroxysmal hemicrania (PH), short-lasting unilateral neuralgiform headache attacks (including SUNCT and SUNA), and hemicrania continua (HC)... (Review)
Review
Cluster headache (CH), paroxysmal hemicrania (PH), short-lasting unilateral neuralgiform headache attacks (including SUNCT and SUNA), and hemicrania continua (HC) compose the group of trigeminal autonomic cephalalgias (TACs). Here, we review the recent advances in the field and summarize the current knowledge about the origin of these headaches. Similar to the other primary headaches, the pathogenesis is still much obscure. However, advances are being made in both animal models and humans studies. Three structures clearly appear to be crucial in the pathophysiology of TACs: the trigeminal nerve, the facial parasympathetic system, and the hypothalamus. The physiologic and pathologic functioning of each of these elements and their interactions is being progressively clarified, but critical questions are still open.
Topics: Animals; Cluster Headache; Headache; Humans; Paroxysmal Hemicrania; SUNCT Syndrome; Trigeminal Autonomic Cephalalgias
PubMed: 32845489
DOI: 10.1007/s10072-020-04639-4 -
Neurological Research Nov 2020Population-based studies on the prevalence of trigeminal neuralgia (TN) worldwide are rare and the epidemiology of TN in Turkey is unknown. The aim of this study is to...
OBJECTIVE
Population-based studies on the prevalence of trigeminal neuralgia (TN) worldwide are rare and the epidemiology of TN in Turkey is unknown. The aim of this study is to determine the prevalence of TN in Turkey.
METHODS
We conducted a cross-sectional, population-based, descriptive epidemiological study in Ereğli, Turkey. Participants over the age of 18 were screened using a self-assessment form, and potential patients were identified by a 'neuroscreening team'. Suspected patients were invited for a clinical examination and evaluated by a senior neurologist. Any required imaging was carried out at a university hospital.
RESULTS
Data were collected from a total of 9605 participants, after the exclusion of 247 individuals who refused to participate. Seven suspected patients were invited to a public health center for clinical evaluation. One patient was diagnosed with SUNCT (Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing) and one patient was diagnosed with post-herpetic neuralgia. A definite diagnosis of TN was confirmed in five participants. The crude prevalence was found to be 52.1/100.000. The mean age of cases was 62.2 ± 8.3 years and the female/male ratio was 4/1. TN was classified as 'symptomatic' in one patient with multiple sclerosis. The other four cases were diagnosed with classical TN. Right side involvement was identified in three cases (60%), whereas left side involvement was seen in two cases (40%).
DISCUSSION
This study establishes the prevalence of TN in Turkey for the first time. The prevalence rate is low when compared with other international studies.
Topics: Adult; Aged; Cross-Sectional Studies; Diagnosis, Differential; Female; Headache; Humans; Male; Middle Aged; Neuralgia; Prevalence; SUNCT Syndrome; Trigeminal Neuralgia; Turkey
PubMed: 32662754
DOI: 10.1080/01616412.2020.1794372 -
Current Pain and Headache Reports May 2020Primary headaches are less common and differ in presentation in older versus younger individuals. Secondary headaches become more common among older patients. (Review)
Review
PURPOSE OF REVIEW
Primary headaches are less common and differ in presentation in older versus younger individuals. Secondary headaches become more common among older patients.
RECENT FINDINGS
Diagnosis and management of headaches in those > 65 years are discussed. Migraine and tension-type headaches are rarely new onset in this age group and should be a diagnosis of exclusion. In older individuals, migraine is more likely to be bilateral with less sensory sensitivities. Migraine aura may present without headache; careful assessment is needed to exclude stroke. Other primary headaches discussed include cough, hypnic, and other headaches. Secondary causes discussed include giant cell arteritis, trigeminal post-herpetic neuropathy, sleep apnea, cardiac cephalgia, cervicogenic pain, vascular etiologies, medications, and burning-mouth syndrome. In older individuals, primary headaches are diagnoses of exclusion, and treatment is affected by comorbidities and polypharmacy. Secondary headaches are a major consideration requiring appropriate workup. Many treatments can safely be offered regardless of age.
Topics: Aged; Burning Mouth Syndrome; Cluster Headache; Giant Cell Arteritis; Headache Disorders, Primary; Headache Disorders, Secondary; Humans; Migraine Disorders; Neuralgia, Postherpetic; Paroxysmal Hemicrania; Post-Traumatic Headache; SUNCT Syndrome; Sleep Apnea Syndromes; Tension-Type Headache; Trigeminal Neuralgia
PubMed: 32472308
DOI: 10.1007/s11916-020-00866-8 -
Headache May 2020We aimed to evaluate the safety and effectiveness of sphenopalatine ganglion pulsed radiofrequency (SPG-PRF) for the treatment of patients with refractory chronic...
OBJECTIVES
We aimed to evaluate the safety and effectiveness of sphenopalatine ganglion pulsed radiofrequency (SPG-PRF) for the treatment of patients with refractory chronic short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and with cranial autonomic symptoms (SUNA).
BACKGROUND
SPG-PRF is a minimally invasive, non-neurodestructive procedure already tested in refractory chronic cluster headache with mixed outcomes. However, no data have been produced in SUNCT/SUNA.
METHODS
This was a prospective clinical audit of outcomes. Consecutive patients with chronic SUNCT/SUNA refractory to medical treatments and treated with SPG-PRF, were included in the analysis. The SPG-PRF was performed percutaneously via a lateral, infra-zygomatic approach. Responders were defined as patients with a reduction in number and/or severity of headache episodes by ≥30% for ≥3 months. Responders to the first procedure were offered to have the treatment repeated.
RESULTS
Nine patients (6 female) were analyzed. After a median follow-up of 30 months (range 2-30), 7 patients were considered responders to the treatment (77.8%) for a median of 6 months (range: 4-10), 1 patient obtained 40% improvement for 2 months, and 1 patient did experience any improvement. No procedure-related immediate or delayed side effects were reported. Three patients (33.3%) experienced a worsening of the head pain for 2-4 weeks immediately after the procedure. Four responders had SPG-PRF repeated; a reproducible response was obtained in two of them.
CONCLUSIONS
In our small series of patients with refractory chronic SUNCT/SUNA, SPG-PRF was a safe and effective treatment modality. The potential reproducible positive effect of subsequent treatments may prevent or delay the use of more invasive and costly interventions for at least a proportion of these patients.
Topics: Adult; Chronic Disease; Clinical Audit; Female; Follow-Up Studies; Ganglia, Parasympathetic; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Prospective Studies; Pterygopalatine Fossa; Pulsed Radiofrequency Treatment; SUNCT Syndrome; Trigeminal Autonomic Cephalalgias
PubMed: 32202666
DOI: 10.1111/head.13788 -
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 National Medical Journal of India 2019A number of treatment options have been used over the years in short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)...
A number of treatment options have been used over the years in short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) with variable results. The most common preventive treatments include carbamazepine, lamotrigine, indomethacin, gabapentin and topiramate. Ketamine is being increasingly used in the treatment of neuropathic pain. The parentral formulations are generally used as oral preparations have poor bioavailability. Recently, ketamine lozenges have been shown to have sufficiently high bioavailability to support their use as a preventive treatment in a number of conditions causing intractable neuropathic pain. We report a 58-year-old man whose symptoms of SUNCT were not responsive to conventional preventive treatments but responded well to a subcutaneous, sub-anaesthetic ketamine infusion and subsequently, sublingual ketamine lozenges.
Topics: Administration, Sublingual; Analgesics, Opioid; Anesthetics, Dissociative; Dose-Response Relationship, Drug; Drug Therapy, Combination; Humans; Infusions, Subcutaneous; Ketamine; Male; Middle Aged; SUNCT Syndrome; Treatment Outcome
PubMed: 31939403
DOI: 10.4103/0970-258X.275347 -
Headache Feb 2020
Topics: Adult; Humans; Male; Phenotype; SUNCT Syndrome; Video Recording
PubMed: 31872425
DOI: 10.1111/head.13727 -
World Neurosurgery Jan 2020Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a primary headache syndrome with an unclear pathogenesis, and...
Gamma Knife Radiosurgery for Short Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) Syndrome: Targeting the Trigeminal Nerve and the Sphenopalatine Ganglion. Case Report and Literature Review.
BACKGROUND
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a primary headache syndrome with an unclear pathogenesis, and only in very few cases, SUNCT is secondary to known lesions (secondary SUNCT). Several pharmacological as well as interventional and invasive treatments have been used to treat SUNT cases, with no definitive results. We describe a patient with idiopathic SUNCT syndrome, successfully treated with gamma knife radiosurgery and we report a review of the cases of the literature treated with radiosurgery.
CASE REPORT
A 63-year-old woman complained of episodes of intense and regular paroxysmal facial pain in the territory of the maxillary branch of the trigeminal nerve accompanied by inflammation of conjunctiva and involuntary lacrimation from 2006. During the following years, she received several treatments: combination of drugs, acupuncture, and endonasal infiltration of the sphenopalatine ganglion. The frequency of the painful attacks increased progressively and it was impossible for her to have a normal active life. Combined gamma knife radiosurgery treatment, targeting the trigeminal nerve (80 Gy maximum dose) and the sphenopalatine ganglion (80 Gy maximum dose) was performed in April 2016 (visual analog score before treatment = 6). Pain gradually reduced in the following months, as well as frequency and severity of the attacks. No sensory deficit developed. The follow-up length of our patient is 37 months: she is nearly pain free (visual analog score = 2) and has resumed a normal life.
CONCLUSIONS
Patients with idiopathic SUNCT have few therapeutic options. Our case demonstrates that gamma knife radiosurgery is a feasible and effective noninvasive option to treat patients with medically refractory idiopathic SUNCT.
Topics: Female; Headache; Humans; Magnetic Resonance Imaging; Middle Aged; Neuralgia; Radiosurgery; SUNCT Syndrome; Treatment Outcome; Trigeminal Nerve
PubMed: 31606507
DOI: 10.1016/j.wneu.2019.10.016