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Neurology Sep 2019Despite the similar phenotypes, comparison between short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and... (Comparative Study)
Comparative Study
OBJECTIVE
Despite the similar phenotypes, comparison between short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with autonomic features (SUNA) has hitherto not been possible due to the dearth of studies validating the phenotype of SUNA. Therefore, these 2 syndromes have been kept separate in the International Classification of Headache Disorders. The aim of this study is to characterize and compare the clinical phenotypes of large clinic-based cohorts of patients with SUNA and SUNCT.
METHODS
The clinical phenotype of consecutive patients with SUNA identified from a single specialist headache center in the United Kingdom between 2007 and 2012 was studied and compared to that of patients with SUNCT.
RESULTS
Sixty-three patients with SUNA (18 male, 28.6%) and 70 patients with SUNCT (32 male, 35.7%) were included. The demographic and clinical characteristics of patients with SUNA were similar to those of patients with SUNCT. Ptosis and rhinorrhea were predictors of SUNCT. The corresponding odds ratios (ORs) (95% confidence interval) were 3.79 (1.64-8.77, = 0.002) and 2.46 (1.09-5.59, = 0.031), respectively. The presence of spontaneous only attacks was a predictor for SUNA (OR 2.58 [1.10-6.05], = 0.029).
CONCLUSION
No major clinical differences have emerged between SUNCT and SUNA, bar the fact that SUNCT is characterized by more prominent cranial autonomic features and triggerability. We propose that the 2 disorders be placed together in a single diagnostic category for which new diagnostic criteria are proposed.
Topics: Adolescent; Adult; Aged; Autonomic Nervous System Diseases; Cohort Studies; Female; Humans; Male; Middle Aged; Neuralgia; Predictive Value of Tests; Prospective Studies; SUNCT Syndrome; Young Adult
PubMed: 31427501
DOI: 10.1212/WNL.0000000000008134 -
Neurology Sep 2019
Topics: Humans; Prospective Studies; SUNCT Syndrome; Trigeminal Nerve
PubMed: 31427500
DOI: 10.1212/WNL.0000000000008121 -
Headache Sep 2019
Topics: Adult; Anticonvulsants; Humans; Lamotrigine; Male; Pituitary Neoplasms; Prolactinoma; SUNCT Syndrome
PubMed: 31373678
DOI: 10.1111/head.13612 -
Neurological Sciences : Official... May 2019Craniofacial pain syndromes are comprised of multiple pathological entities resulting in pain referred to the scalp, face, or deeper cranial structures. In a small... (Review)
Review
Craniofacial pain syndromes are comprised of multiple pathological entities resulting in pain referred to the scalp, face, or deeper cranial structures. In a small subset of patients affected by those syndromes, pharmacological and physical therapies fail in alleviating pain. In some of those refractory patients surgical procedures aimed at relieving pain are indicated and have been adopted with variable results and safety profiles. In this review, the authors describe craniofacial pain syndromes that most commonly fail to respond to pharmacological therapies and may be amenable to tailored surgical procedures. In particular, trigeminal, glossopharyngeal, and occipital neuralgias are considered, as well as some primary headache syndromes such as cluster headache, short unilateral neuralgiform headache with conjunctival injection and tearing/short unilateral neuralgiform headache with autonomic symptoms, and migraine. Surgical techniques, including the implantation of deep brain or peripheral nerve electrodes with subsequent chronic stimulation, microvascular decompression of neurovascular conflicts, and percutaneous lesioning of neural structures are described. Finally, surgical indications, outcomes, and safety of these procedures are presented.
Topics: Facial Neuralgia; Headache; Humans; Microvascular Decompression Surgery; Migraine Disorders; Neurosurgical Procedures; SUNCT Syndrome; Trigeminal Autonomic Cephalalgias
PubMed: 30835002
DOI: 10.1007/s10072-019-03789-4 -
Journal of Oral & Facial Pain and...Trigeminal autonomic cephalalgias (TACs) are primary headaches that include cluster headache (CH), paroxysmal hemicrania (PH), and short-lasting unilateral neuralgiform... (Review)
Review
Trigeminal autonomic cephalalgias (TACs) are primary headaches that include cluster headache (CH), paroxysmal hemicrania (PH), and short-lasting unilateral neuralgiform headache attacks (SUNHAs) with conjunctival injection and tearing (SUNCT) or cranial autonomic features (SUNA). Hemicrania continua (HC) is another form that has been ascribed to TACs for clinical and pathophysiologic reasons. Cluster headache is the most common of these syndromes, even if comparatively rare, with a lifetime prevalence of around 1 in 1,000. TACs share many aspects from a pathophysiologic standpoint (a hypothalamic activation may be involved in all forms initiating the attacks), but differences in attack duration and frequency and in extent of treatment response distinguish one from the other. This review focuses on the treatments currently available for these headaches according to the most recent guidelines. Due to the low frequency of most TACs, there are little data from randomized controlled trials; therefore, evidence from simple open studies in small case series or single-case observations are reported. Promising results have been recently obtained with novel modes of drug administration, invasive pericranial interventions, and different strategies such as neurostimulation. There are also some future treatments being studied at present.
Topics: Cluster Headache; Headache; Humans; SUNCT Syndrome; Trigeminal Autonomic Cephalalgias
PubMed: 30703174
DOI: 10.11607/ofph.1922 -
Cephalalgia : An International Journal... Apr 2019Short-lasting unilateral neuralgiform headaches include those with conjunctival injection and tearing and with cranial autonomic symptoms. Most frequently reported as...
BACKGROUND
Short-lasting unilateral neuralgiform headaches include those with conjunctival injection and tearing and with cranial autonomic symptoms. Most frequently reported as idiopathic, there is a growing number of symptomatic cases described.
CASE REPORT
A 57-year old man presented a 16-year history of right hemifacial short-lasting pain attacks accompanied by ipsilateral autonomic symptoms and simultaneous malar contractions. Brain MRI disclosed a right acoustic neuroma compressing the right facial nerve and a venous developmental anomaly perpendicular to the right facial nerve root entry zone, without lesions affecting the trigeminal nerve. He was started on lamotrigine, resulting in complete remission of pain attacks, autonomic signs and facial contractions.
CONCLUSIONS
This patient presents a typical short-lasting unilateral neuralgiform headache with response to lamotrigine. The uniqueness of the case is the co-occurring malar contractions, evocative of facial nerve involvement. We speculate whether facial nerve compression renders this nerve more susceptible to triggering during a short-lasting unilateral neuralgiform headache attack.
Topics: Calcium Channel Blockers; Hemifacial Spasm; Humans; Lamotrigine; Male; Middle Aged; SUNCT Syndrome
PubMed: 30482045
DOI: 10.1177/0333102418815652 -
Headache Jan 2019
Topics: Aged; Encephalitis, Varicella Zoster; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; SUNCT Syndrome
PubMed: 30446992
DOI: 10.1111/head.13447 -
Pain Medicine (Malden, Mass.) Feb 2019
Topics: Adult; Cluster Headache; Humans; Male; SUNCT Syndrome
PubMed: 30107598
DOI: 10.1093/pm/pny161 -
Current Pain and Headache Reports Jun 2018The purpose of this review is to provide an update on the clinical features, diagnosis, pathogenesis, epidemiology, and treatment of the rare primary headache disorders... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to provide an update on the clinical features, diagnosis, pathogenesis, epidemiology, and treatment of the rare primary headache disorders short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA). Together these entities are known as short-lasting unilateral neuralgiform headache attacks (SUNHA).
RECENT FINDINGS
Recent case reports of secondary SUNCT and SUNA due to medullary infarcts support the theory that the trigeminohypothalamic pathway is involved in the pathophysiology of SUNHA. While medical therapy for SUNHA has not significantly changed, surgical therapy for refractory SUNCT and SUNA has made advancements with a recent case series demonstrating the efficacy of deep brain stimulation. We will discuss the pathophysiology of both the pain and the autonomic symptoms experienced in SUNCT and SUNA attacks as well the medical, procedural, and surgical options for treatment with emphasis on recent advances. Specific secondary causes reported in the recent literature will be discussed in brief.
Topics: Humans; SUNCT Syndrome; Trigeminal Autonomic Cephalalgias
PubMed: 29931416
DOI: 10.1007/s11916-018-0707-3 -
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