Objective.-To describe the statuslike pattern of SUNCT (short-lasting unilateral neuralgiform pain with conjunctival injection and tearing) in two young women.Background.-SUNCT syndrome is a rare condition characterized by a short-lasting periocular pain associated with marked autonomic symptoms. Twenty-five cases have been reported in the literature with a high preponderance of males and a mean age of 51 years. The frequency of episodes shows a wide variability, not just among individuals but also in the same patient, and a statuslike pattern of almost continuous attacks has been described.Methods.-We report the cases of two young women (aged 26 and 23 years) with typical SUNCT features who suffered bouts of up to 60 paroxysms of pain per hour. Paraclinical investigations showed no abnormalities.Conclusions.-Although unusual, paroxysms in SUNCT may overlap into a clinical status. A strong relationship with hormonal changes was noted in one patient. In both cases, the pain was refractory to treatment with indomethacin, carbamazepine, and hypnotics, and only intravenous methylprednisolone with oral carbamazepine may have been partially effective in one case. Key words: SUNCT, unilateral headaches, steroids, carbamazepineAbbreviations: SUNCT short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing ( Headache 2001;41:826-829) In 1978, Sjaastad et al 1 described an entity termed SUNCT (short-lasting unilateral neuralgiform pain with conjunctival injection and tearing) characterized by recurrent, brief (15 to 120 seconds) unilateral pain attacks localized in the periocular area, with a rather abrupt onset and end, associated with marked ipsilateral autonomic features (massive conjunctival injection, watering of the eye, rhinorrhea, subclinical forehead sweating, and changes in cardiovascular variables). SUNCT has been classified among the trigeminal autonomic cephalgias and new diagnostic criteria have recently been proposed. 2,3 Generally, SUNCT starts around aged 51 years, with a range between 41 and 70 years for most cases. 4 Until 1994 when two women were reported, only men had been described. 5 The sex ratio for 25 reported cases is 2.57 men for every woman. 4 The frequency of attacks shows great variability not only between individuals but also in the same patient. The number of paroxysms may range from a few attacks per day to nearly continuous attacks, in what has been termed SUNCT status , which is an almost unbearable condition due to the intensity and frequency of the attacks. [6][7][8] We describe the statuslike pattern of the SUNCT syndrome in two young women. METHODSThe clinical notes of 254 patients with a diagnosis of cluster-type headache were reviewed. SUNCT was diagnosed when the patients had moderate to severe,

We evaluated the efficacy of intravenous boluses of methylprednisolone followed by prednisone as a prophylactic treatment for episodic cluster headache. Fourteen male patients (mean age, 42.54 years) with episodic cluster headache were treated with 250-mg boluses of methylprednisolone on 3 consecutive days, followed by prednisone (90 mg/day orally) with gradual tapering in four weeks. Headache parameters of the active phases treated with methylprednisolone were compared with those of previous active phases in the same patients treated with other prophylactic medications. The primary efficacy criterion was decrease in the frequency of attacks during the first month of treatment. The statistical differences were calculated using Wilcoxon's test. The attacks were significantly less frequent in the active phases treated with methylprednisolone boluses than those treated with other medications ( p<0.05). This treatment seems to be more effective than the usual prophylactic treatments for episodic cluster headache.

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