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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 -
Ideggyogyaszati Szemle Sep 2017SUNCT syndrome, a rare form of primary headaches, may be secondary to pituitary tumours. The secondary forms usually related with prolactinomas. The response of dopamin...
SUNCT syndrome, a rare form of primary headaches, may be secondary to pituitary tumours. The secondary forms usually related with prolactinomas. The response of dopamin agonists could be variable. In this study, we reported a case of SUNCT syndrome secondary to prolactinoma. Cranial magnetic resonance imaging was performed for this patient because of the increase in pain severity and frequency. A hemorrhage was detected into the prolactinoma ipsilateral to the pain. The headache attacks were taken undercontrol and remission was ensured with cabergoline in a short time.
Topics: Brain; Cerebral Hemorrhage; Humans; Prolactinoma; SUNCT Syndrome
PubMed: 29870628
DOI: 10.18071/isz.70.0355 -
Journal of Clinical Neurology (Seoul,... Oct 2018Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a primary headache syndrome with an unclear pathogenesis.... (Review)
Review
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a primary headache syndrome with an unclear pathogenesis. However, there is increasing evidence in the literature for secondary SUNCT being attributable to certain known lesions. We explored the possible neurobiological mechanism underlying SUNCT based on all reported cases of secondary SUNCT for which detailed information is available. Here we report a case of neuromyelitis optica spectrum disorders that had typical symptoms of SUNCT that might have been attributable to involvement of the spinal nucleus of the trigeminal nerve. We also review cases of secondary SUNCT reported in the English-language literature and analyze them for demographic characteristics, clinical features, response to treatment, and imaging findings. The literature review shows that secondary SUNCT can derive from a neoplasm, vascular disease, trauma, infection, inflammation, or congenital malformation. The pons with involvement of the trigeminal root entry zone was the most commonly affected region for inducing secondary SUNCT. In conclusion, the neurobiology of secondary SUNCT includes structures such as the nucleus and the trigeminal nerve with its branches, suggesting that some cases of primary SUNCT have underlying mechanisms that are related to existing focal damage that cannot be visualized.
PubMed: 29856156
DOI: 10.3988/jcn.2018.14.4.433 -
Annals of Indian Academy of Neurology Apr 2018The term "Trigeminal Autonomic Cephalalgia (TAC)" was first coined by Goadsby and Lipton[1] to include a group of relatively rare primary headache disorders... (Review)
Review
The term "Trigeminal Autonomic Cephalalgia (TAC)" was first coined by Goadsby and Lipton[1] to include a group of relatively rare primary headache disorders characterized by moderate to severe, short-lived head pain in the trigeminal distribution with unilateral cranial parasympathetic autonomic features, such as lacrimation, rhinorrhea, conjunctival injection, eyelid edema, and ptosis. In the current International Classification of Headache Disorders (ICHD-3 beta),[2] the TAC group includes cluster headache (CH), paroxysmal hemicrania (PH), short-lasting unilateral neuralgiform headache attacks (SUNHAs) and their 2 subforms - SUNHAs with conjunctival injection and tearing (SUNCT), SUNHAs with cranial autonomic symptoms (SUNA). Hemicrania Continua (HC) is also now included in the TAC group. Although the entities included under TACs seem broadly similar, they differ in attack duration, frequency and their response to different treatments. At one end of the spectrum lies CH, the prototypic TAC where the duration of attacks is the longest and at the other end is the SUNCT syndrome where the duration is shortest. There is some overlap across the entities; they are not difficult to recognize and subclassify. The umbrella term "TAC" for the short-lasting headaches with autonomic features was for the first time introduced in The ICHD, 2 edition (ICHD-2) published in 2004.[3] The beta version of the 3 edition of The ICHD[2] was published in 2013. Headache classification being an evolving process, there have been some changes within the TAC group between ICHD-2 and ICHD-3 beta.[45] Diagnostic criteria have been revised to reflect pathophysiological and clinical observations. Neuroimaging has provided insights into the pathophysiology of TACs. Functional neuroimaging has helped to elucidate key structures activated during attacks of TACs. Correct diagnosis remains the key to correct management of the TACs because treatment options vary. The aim of this article will be to highlight the changes in ICHD-3 beta to this group and to emphasize the clinical implications of these changes. Description of individual entities included under TACs are included elsewhere and will therefore not be detailed here.
PubMed: 29720818
DOI: 10.4103/aian.AIAN_350_17 -
Emergencias : Revista de La Sociedad... Jun 2018
Clinical spectrum of associated SUNCT (shortlasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) and trigeminal neuralgia: a multidisciplinary approach in the emergency department.
Topics: Diagnosis, Differential; Emergency Service, Hospital; Female; Humans; Middle Aged; Patient Care Team; SUNCT Syndrome; Trigeminal Neuralgia
PubMed: 29687680
DOI: No ID Found -
Agri : Agri (Algoloji) Dernegi'nin... Jan 2018Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare, primary headache syndrome, which is classified as a...
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare, primary headache syndrome, which is classified as a subtype of trigeminal autonomic cephalalgias. Although SUNCT is usually refractory to treatment, several antiepileptic drugs have recently shown promising results for its treatment. However, there is a lack of evidence regarding the course of SUNCT during pregnancy and the available treatment options. Here, we present a 30-week pregnant female with SUNCT who was successfully treated with infra- and supraorbital nerve blocks. Headache attacks completely diminished after the injection, and recurrence was not observed. Although lamotrigine may be relatively safe in pregnant patients with SUNCT attacks, peripheral nerve block may be a feasible technique and can be considered as a safe and effective treatment option. This is the first SUNCT case in the literature that was successfully treated with infra- and supraorbital nerve blocks during pregnancy.
Topics: Adult; Anticonvulsants; Diagnosis, Differential; Female; Headache; Humans; Lamotrigine; Nerve Block; Neuralgia; Pregnancy; Pregnancy Complications; Prenatal Diagnosis; Triazines
PubMed: 29450873
DOI: 10.5505/agri.2016.25991 -
Case Reports in Infectious Diseases 2017Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome (SUNCT) is a type of trigeminal autonomic cephalalgia. Its...
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome (SUNCT) is a type of trigeminal autonomic cephalalgia. Its etiology is generally idiopathic, though rarely it has been associated with viral infections. We describe the fourth case reported in the literature of SUNCT in association with viral meningoencephalitis.
PubMed: 29250449
DOI: 10.1155/2017/8928017 -
Cephalalgia : An International Journal... Aug 2018Background Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache... (Randomized Controlled Trial)
Randomized Controlled Trial
Background Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) are two rare headache syndromes classified broadly as Trigeminal Autonomic Cephalalgias (TACs). Methods Here, 65 SUNCT (37 males) and 37 SUNA (18 males) patients were studied to describe their clinical manifestations and responses to treatment. Results Pain was almost always unilateral and side-locked. There were three types of attack: Single stabs, stab groups, and a saw-tooth pattern, with some patients experiencing a mixture of two types. As to cranial autonomic symptoms, SUNA patients mainly had lacrimation (41%) and ptosis (40%). Most cases of the two syndromes had attack triggers, and the most common triggers were touching, chewing, or eating for SUNCT, and chewing/eating and touching for SUNA. More than half of each group had a personal or family history of migraine that resulted in more likely photophobia, phonophobia and persistent pain between attacks. For short-term prevention, both syndromes were highly responsive to intravenous lidocaine by infusion; for long-term prevention, lamotrigine and topiramate were effective for SUNCT, and lamotrigine and gabapentin were efficacious in preventing SUNA attacks. A randomized placebo-controlled cross-over trial of topiramate in SUNCT using an N-of-1 design demonstrated it to be an effective treatment in line with clinical experience. Conclusions SUNCT and SUNA are rare primary headache disorders that are distinct and very often tractable to medical therapy.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics; Anticonvulsants; Cross-Over Studies; Female; Follow-Up Studies; Gabapentin; Headache; Humans; Lamotrigine; Male; Middle Aged; Phenotype; SUNCT Syndrome; Topiramate; Treatment Outcome; Young Adult
PubMed: 29096522
DOI: 10.1177/0333102417739304 -
The Journal of Headache and Pain Dec 2017Hemicrania continua (HC), paroxysmal hemicrania (PH) and short lasting neuralgiform headache attacks (SUNCT and SUNA) are rare syndromes with a difficult therapeutic... (Review)
Review
BACKGROUND
Hemicrania continua (HC), paroxysmal hemicrania (PH) and short lasting neuralgiform headache attacks (SUNCT and SUNA) are rare syndromes with a difficult therapeutic approach. The aim of this review is to summarize all articles dealing with treatments for HC, PH, SUNCT and SUNA, comparing them in terms of effectiveness and safety.
METHODS
A survey was performed using the pubmed database for documents published from the 1st January 1989 onwards. All types of articles were considered, those ones dealing with symptomatic cases and non-English written ones were excluded.
RESULTS
Indomethacin is the best treatment both for HC and PH. For the acute treatment of HC, piroxicam and celecoxib have shown good results, whilst for the prolonged treatment celecoxib, topiramate and gabapentin are good options besides indomethacin. For PH the best drug besides indomethacin is piroxicam, both for acute and prolonged treatment. For SUNCT and SUNA the most effective treatments are intravenous or subcutaneous lidocaine for the acute treatment of active phases and lamotrigine for the their prevention. Other effective therapeutic options are intravenous steroids for acute treatment and topiramate for prolonged treatment. Non-pharmacological techniques have shown good results in SUNCT and SUNA but, since they have been tried on a small number of patients, the reliability of their efficacy is poor and their safety profile mostly unknown.
CONCLUSIONS
Besides a great number of treatments tried, HC, PH, SUNCT and SUNA management remains difficult, according with their unknown pathogenesis and their rarity, which strongly limits the studies upon these conditions. Further studies are needed to better define the treatment of choice for these conditions.
Topics: Amines; Analgesics; Anticonvulsants; Cyclohexanecarboxylic Acids; Female; Fructose; Gabapentin; Humans; Indomethacin; Lamotrigine; Lidocaine; Male; Neuralgia; Paroxysmal Hemicrania; Reproducibility of Results; SUNCT Syndrome; Surveys and Questionnaires; Topiramate; Triazines; Trigeminal Autonomic Cephalalgias; gamma-Aminobutyric Acid
PubMed: 28730562
DOI: 10.1186/s10194-017-0777-3 -
Noro Psikiyatri Arsivi Jun 2016
PubMed: 28360795
DOI: 10.5152/npa.2015.10266