A Case of SUNCT Syndrome Responsive to Verapamil

Abstract

SUNCT is a rare headache disorder, first described by Sjaastad et al. in 1989 (1) and recently codified by the International Classification of Headache Disorders as a primary headache (2). The literature, however, discloses some cases of secondary SUNCT syndrome, particularly due to lesions in the posterior fossa or involving the pituitary gland (3-10). The pharmacological treatment of this syndrome is problematic. Some encouraging results have been recently suggested with lamotrigine (11-15), gabapentin (16, 17) and topiramate (18, 19); all previous attempts at treatment with drugs used for other short-lasting headaches were unsuccessful (20). It is noteworthy that two reports (21, 22) even reported a worsening effect of verapamil in patients affected by SUNCT. We describe a patient with SUNCT syndrome and an ischaemic lesion in the posterior fossa, who was successfully treated with verapamil.

SUNCT and SUNA: Clinical features and medical treatment

“…47 Cases of symptomatic SUNCT have been reported, including vascular malformations, 48-50 basilar impression, 51 presumed brain stem infarction, 52 a leiomyosarcoma of the cavernous sinus, 53 craniosynostosis, 54 prolactinoma 55,56 and acromegaly. 57 The anecdotal effectiveness of verapamil, 8 carbamazepine, 58 gabapentin 9,10 and topiramate 14,15 were not confirmed in this study. However, verapamil was only used once and the doses of carbamazepine and gabapentin were possibly suboptimal, but in most cases were the maximum tolerated.…”

“…7 There are anecdotal reports in the literature of various agents that have been effective in individual patients. These include verapamil, 8 gabapentin, 9,10 lamotrigine 11-13 and topiramate. 14,15 One difficulty in assessing medication response is that spontaneous remission may occur and can be prolonged.…”

SUNCT Syndrome: Short-Lasting Unilateral Neuralgiform Headache with Conjunctival Injection and Tearing

“…Calcium channel blockers have previously been reported to exacerbate symptoms, although one recent case report describes a beneficial response to verapamil. 12 One case report documents slight improvement with sumatriptan and another with valproate. Partial improvement was observed in several patients treated with carbemazapine.…”

Familial aggregation of cluster headache

“…According to some authors, there may be some shared aspects in the physiopathology of the trigeminal autonomic headaches 21 . Furthermore, there are some case reports of successful usage of drugs like vera pamil (most commonly used in CH) in patients with SUNCT 22 . While these findings may suggest some overlap between CH and SUCNT, it seems more likely that the exceedingly high number of cases in our study may be due to the origin of our sample (a tertiary headache clinic).…”