Cluster headache and SUNCT: similarities and differences

Abstract

IntroductionOur first case of SUNCT was found in 1978 [1], and a total of three cases were later published under the common name "shortlasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing" in 1989 [2]. Currently, SUNCT is defined by the International Association for the Study of Pain (IASP) as "Repetitive paroxysms of unilateral shortlasting pain, usually 15-120 seconds duration, mainly in the ocular and the periocular areas, of a neuralgiform nature and moderate to severe intensity, usually appearing only during daytime and accompanied by ipsilateral marked conjunctival injection, lacrimation, a low to moderate degree of rhinorrhea, and subclinical forehead sweating", and belongs to the group of neuralgias of the head and face [3]. Furthermore, the pain paroxysms accompanied by autonomic phenomena tend to appear in cluster periods, and there is a clear male preponderance in SUNCT [3]. Thus, SUNCT has even been considered to be in the same group as cluster headache (CH) [4,5]. Abstract SUNCT is probably a distinct syndrome, although it shares some common features with cluster headache (CH): male sex preponderance, clustering of attacks, unilaterality of headache without sideshift, pain of non-pulsating type with its maximum in the periocular area, ipsilateral autonomic phenomena (e.g. conjunctival injection, lacrimation, rhinorrhea, increased forehead sweating), systemic blood pressure increment with heart rate decrement, blood flow velocity decrement in the middle cerebral artery, and hyperventilation. In spite of these similarities, SUNCT syndrome differs clearly from CH as regards a number of clinical variables, such as duration, intensity, frequency, and nocturnal preponderance of attacks. The two syndromes also differ markedly as regards precipitation of attacks, the usual age at onset, and efficacy of various treatment alternatives.Laboratory investigations have disclosed differences as regards presence or absence of Horner-like picture and possibly also the respiratory sinus arrhythmia pattern. All in all, these differences seem sufficiently ponderous to make it likely that SUNCT syndrome and CH differ essentially. SUNCT seems to be a "neuralgiform" headache, but different from trigeminal neuralgia.

Trigeminal autonomic cephalgias

“…Боль не купируется кар-бамазепином и индометацином [52]. Некоторые авторы считают SUNCT-синдром формой невралгии тройнично-го нерва [53].…”

Algies faciales

“…Parmi les algies vasculaires des douleurs situées principalement au niveau du visage, les «Cluster headaches» (névralgie d'Horton, érythroprosopalgie, céphalée en grappe) [1][2][3][4] sont les plus fréquentes. Elles touchent le plus souvent les hommes et les premières attaques débutent seulement à un âge moyen.…”

“…Mais il faut avouer que les formes mixtes ne sont pas si rares! Le syndrome de SUNCT (short lasting unilateral neuralgiform headache with conjunctival injection and tearing) ressemble au Cluster headache [1,2,5,6]. Les douleurs sont cepen- La réponse au traitement est aléatoire.…”