Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing: Response to antiepileptic dual therapy

Abstract

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is included among trigeminal autonomic cephalalgias in the International Classification of Headache Disorders-2. Available literature suggests that it responds to anticonvulsants, particularly lamotrigine. However, management of partial responders is difficult and antiepileptic duo-therapy may be an answer to it. Nonetheless, to our knowledge, anticonvulsant combination has never been tried in partial responders to monotherapy. We are presenting a case of SUNCT that had overlapping symptoms with Short-lasting Unilateral Neuralgiform headache attacks with cranial Autonomic features and responded well only to the combination of lamotrigine with carbamazepine. However, lamotrigine had to be stopped as patient developed leucopenia and it resulted in partial recurrence of symptoms.

SUNCT, SUNA and pituitary tumors: Clinical characteristics and treatment

“…Based on case reports, lamotrigine appears to be the most effective medication for SUNCT (8,38–43). Other treatment options include gabapentin, topiramate, verapamil, carbamazepine, oxcarbazepine, zonisamide, intravenous lidocaine, intravenous phenytoin, and greater occipital nerve block (19,44–59). Intravenous lidocaine has been reported to completely abolish the pain in many patients with both SUNCT and SUNA.…”

Steroid tedavisine yanıt veren dirençli SUNCT olgusu

“…Marziniak et al, on the other hand, achieved good outcome with oxcarbazepine and gabapentin (17). Grupta et al also reported favorably about lamotrigine in a SUNCT case (18).…”

The Role of Lamotrigine in the Treatment of Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing Syndrome

“…26 This was discovered when carbamazepine 600 mg/day was concurrently being tapered with the titration of lamotrigine to 100 mg/day. The dual regimen was discontinued after the patient developed leukopenia with dual therapy.…”