Botulinum Toxin A for the Treatment of a Child with SUNCT Syndrome

Zhang, Yi; Zhang, Haifeng; Lian, Yajun; Ma, Yunqing; Xie, Ning; Chen, Xuan; Zhang, Lu

doi:10.1155/2016/8016065

Cited by 20 publications

(15 citation statements)

References 26 publications

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“…Other medications more frequently reported to treat SUNHA include carbamazepine, corticosteroids, lidocaine, and pregabalin (2,14,28). Case reports are also available regarding onabotulinumtoxinA used to treat SUNHA (29,30), hormone replacement therapy (31), infra- and supraorbital nerve blocks (32), and non-invasive vagal nerve stimulation (33). Surgical options are reported, including occipital nerve stimulation (34), microvascular decompression (35), and deep brain stimulation (36).…”

Section: Discussionmentioning

confidence: 99%

SUNCT/SUNA: Case series presenting in an orofacial pain clinic

2020

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Aim Little is known about short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). We present our experience with SUNCT/SUNA patients to aid identification and management of these disorders. Methods A retrospective review of patient records of one orofacial pain clinic was performed. Inclusion criteria was a diagnosis of SUNCT/SUNA confirmed with at least one follow-up visit. Results Six of the 2464 new patients seen between 2015–2018 met the selection criteria (SUNCT n = 2, SUNA n = 4). Gender distribution was one male to one female and average age of diagnosis was 52 years (range 26–62). Attacks were located in the V1/V2 trigeminal distributions, and five patients reported associated intraoral pain. Pain quality was sharp, shooting, and burning with two patients reporting “numbness”. Pain was moderate-severe in intensity, with daily episodes that typically lasted for seconds. Common autonomic features were lacrimation, conjunctival injection, rhinorrhea, and flushing. Frequent triggers were touching the nose or a specific intraoral area. Lamotrigine and gabapentin were commonly used as initial therapy. Conclusions Differentiating between SUNCT/SUNA does not appear to be clinically relevant. Presenting symptoms were consistent with those published, except 5/6 patients describing intraoral pain and two patients describing paresthesia.

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Section: Discussionmentioning

confidence: 99%

SUNCT/SUNA: Case series presenting in an orofacial pain clinic

2020

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“…However, SUNCT-like syndromes caused by intracranial lesions are reported among adults [ 3 , 12 ], as shown in Table 2 . These encompass (1) posterior fossa pathologies, such as pilocytic astrocytoma, cavernous hemangioma, arteriovenous malformation, dorsal–lateral brainstem ischemic lesions, skull malformation or HIV-related lesions [ 7 , 9 , 13 , 14 , 15 , 16 , 17 , 18 ]; (2) pituitary pathology, such as microadenomas or macroadenomas, with prolactinomas being the most common type [ 3 , 4 , 7 , 9 , 12 , 13 , 17 , 19 ]; (3) neoplastic lesions within the cavernous sinus, venous sinus or the orbits [ 3 , 9 ]; and (4) vascular loops and trigeminal neurovascular conflict, ipsilaterally to the side of the pain [ 4 , 9 , 13 ].…”

Section: Resultsmentioning

confidence: 99%

“…The ICHD-3 defines SUNHA headaches as “attacks of moderate or severe, strictly unilateral head pain lasting from seconds to minutes, occurring at least once a day and usually associated with prominent lacrimation and redness of the ipsilateral eye” [ 1 ]. The difference between SUNCT and SUNA lies in the local autonomic signs accompanying the attacks: both ipsilateral conjunctival injection and tearing characterize SUNCT, while either one or the other, along with other cranial autonomic signs, appears in SUNA [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. SUNHA, and TACs in general, are relatively rare in adults, and even rarer in the pediatric population [ 2 , 3 , 9 , 10 ]; hence, they are poorly recognized.…”

Section: Introductionmentioning

confidence: 99%

“…The difference between SUNCT and SUNA lies in the local autonomic signs accompanying the attacks: both ipsilateral conjunctival injection and tearing characterize SUNCT, while either one or the other, along with other cranial autonomic signs, appears in SUNA [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. SUNHA, and TACs in general, are relatively rare in adults, and even rarer in the pediatric population [ 2 , 3 , 9 , 10 ]; hence, they are poorly recognized. The lack of awareness about this condition among clinicians could expose patients to the consequences of “diagnostic odysseys” [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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SUNCT/SUNA in Pediatric Age: A Review of Pathophysiology and Therapeutic Options

et al. 2021

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The International Classification of Headache Disorders, 3rd edition (ICHD3) defines Short-lasting Unilateral Neuralgiform Headache Attacks (SUNHA) as attacks of moderate or severe, strictly unilateral head pain lasting from seconds to minutes, occurring at least once a day and usually associated with prominent lacrimation and redness of the ipsilateral eye. Two subtypes of SUNHA are identified: Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT) and Short-lasting Unilateral Neuralgiform headache attacks with cranial Autonomic symptoms (SUNA). These pathologies are infrequent in children and difficult to diagnose. The authors reviewed the existing literature on SUNCT and SUNA, especially in the developmental age, which describes the pathophysiology in detail and focuses on the therapeutic options available to date. SUNHA-type headaches must be considered on the one hand, for the possibility of the onset of forms secondary to underlying pathologies even of a neoplastic nature, and on the other hand, for the negative impact they can have on an individual’s quality of life, particularly in young patients. Until now, published cases suggest that no chronic variants occur in childhood and adolescents. In light of this evidence, the authors offer a review that may serve as a source to be drawn upon in the implementation of suitable treatments in children and adolescents suffering from these headaches, focusing on therapies that are non-invasive and as risk-free as possible for pediatric patients.

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“…There are two case reports of positive response to botulinum toxin injections [52,53]. The effect of botulinum toxin should be considered uncertain until more evidence is gathered.…”

Section: Botulinum Toxinmentioning

confidence: 99%

Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses

Stubberud

Tronvik

Matharu

2020

Curr Treat Options Neurol

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Purpose of Review This review presents a critical appraisal of the treatment strategies for short-lasting unilateral neuralgiform headache attacks (SUNHA), paroxysmal hemicrania (PH), and hemicrania continua (HC). We assess the available, though sparse, evidence on both medical and surgical treatments. In addition, we present estimated pooled analyses of the most common treatments and emphasize recent promising findings. Recent Findings The majority of literature available on the treatment of these rare trigeminal autonomic cephalalgias are small open-label observational studies and case reports. Pooled analyses reveal that lamotrigine for SUNHA and indomethacin for PH and HC are the preventative treatments of choice. Second-line choices include topiramate, gabapentin, and carbamazepine for SUNHA; verapamil for PH; and cyclooxygenase-2 inhibitors and gabapentin for HC. Parenteral lidocaine is highly effective as a transitional treatment for SUNHA. Novel therapeutic strategies such as non-invasive neurostimulation, targeted nerve and ganglion blockades, and invasive neurostimulation, including implanted occipital nerve stimulators and deep brain stimulation, appears to be promising options. Summary At present, lamotrigine as a prophylactic and parenteral lidocaine as transitional treatment remain the therapies of choice for SUNHA. While, by definition, both PH and CH respond exquisitely to indomethacin, evidence for other prophylactics is less convincing. Evidence for the novel emerging therapies is limited, though promising.

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Botulinum Toxin A for the Treatment of a Child with SUNCT Syndrome

Cited by 20 publications

References 26 publications

SUNCT/SUNA: Case series presenting in an orofacial pain clinic

SUNCT/SUNA: Case series presenting in an orofacial pain clinic

SUNCT/SUNA in Pediatric Age: A Review of Pathophysiology and Therapeutic Options

Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses

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