Peripheral nerve blocks in the treatment of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) during pregnancy

Abstract

ÖzetKonjunktival injeksiyon ve göz yaşarması ile birlikte kısa-süreli unilateral nevraljifrm başağrısı atakları (SUNCT), trigeminal otonomik başağrıları içerisinde sınıflandırılan nadir gözlenen bir primer başağrısı bozukluğudur. SUNCT genellikle tedaviye dirençli bir sendrom olarak kabul edilmesine rağmen son yıllarda antiepileptik ilaçlar ile anlamlı düzelme bildirilmektedir. Hastalığın gebelikteki seyri ve tedavisi ile ilgili literatürde bilgi yoktur. Bu çalışmada 30 haftalık gebelik sırasında SUNCT atağı yaşayan, infra-ve supraorbital sinir blokajı ile başarılı bir şekilde tedavi edilen bir olgu sunulmaktadır. Aslında gebelik döne-minde lamotrijin kısmen güvenli olarak kullanılmaktadır, fakat periferal sinir blokajı uygulanması pratik, güvenli ve etkin bir alternatif tedavi seçeneğidir. Bu olgu literatürde gebelik döneminde infra-ve supraorbital sinir blokajı ile başarılı bir şekilde tedavi edilen ilk SUNCT hastasıdır.Anahtar sözcükler: Infraorbital; sinir blokajı; SUNCT; supraorbital. SummaryShort-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare, primary headache syndrome, which is classified as a subtype of trigeminal autonomic cephalalgias. Although SUNCT is usually refractory to treatment, several antiepileptic drugs have recently shown promising results for its treatment. However, there is a lack of evidence regarding the course of SUNCT during pregnancy and the available treatment options. Here, we present a 30-week pregnant female with SUNCT who was successfully treated with infra-and supraorbital nerve blocks. Headache attacks completely diminished after the injection, and recurrence was not observed. Although lamotrigine may be relatively safe in pregnant patients with SUNCT attacks, peripheral nerve block may be a feasible technique and can be considered as a safe and effective treatment option. This is the first SUNCT case in the literature that was successfully treated with infra-and supraorbital nerve blocks during pregnancy.

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) responsive to intranasal lidocaine and nerve blockage: a case report

“…Intranasal administration of lidocaine with the technique described herein and nerve blockade are inexpensive, relatively low-risk and requiring only short term training besides were hereby reported to be effective treatments of SUNCT. Similar treatments have been previously reported both for SUNCT and SUNA with satisfactory results 3,4 but data on this topic is still scarce in the literature, with no known reports of trials with patients with this condition associating both treatments. Potential advantages of intranasal over intravenous lidocaine are: 1) widespread availability and inexpensive material needed for the application; 2) avoidance of a critical care bed, which decreases immensely the financial burden of treatment; and 3) potential fewer systemic side effects.…”

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

“…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).…”

Management of Trigeminal Autonomic Cephalalgias Including Chronic Cluster

“…Among procedural treatments, efficacy of occipital nerve major blocks and infraorbital and supraorbital nerve blocks have been described . There are also positive therapeutic effects of microvascular decompression of the trigeminal nerve root that have recently been confirmed in a larger population The largest study so far was an uncontrolled open-label prospective single-center study conducted between 2012 and 2020 to evaluate the efficacy and safety of trigeminal microvascular decompression in refractory chronic SUNCT or SUNA in patients with magnetic resonance imaging evidence of trigeminal neurovascular conflict ipsilateral to the pain side .…”