Statuslike SUNCT in Two Young Women

Abstract

Objective.-To describe the statuslike pattern of SUNCT (short-lasting unilateral neuralgiform pain with conjunctival injection and tearing) in two young women.Background.-SUNCT syndrome is a rare condition characterized by a short-lasting periocular pain associated with marked autonomic symptoms. Twenty-five cases have been reported in the literature with a high preponderance of males and a mean age of 51 years. The frequency of episodes shows a wide variability, not just among individuals but also in the same patient, and a statuslike pattern of almost continuous attacks has been described.Methods.-We report the cases of two young women (aged 26 and 23 years) with typical SUNCT features who suffered bouts of up to 60 paroxysms of pain per hour. Paraclinical investigations showed no abnormalities.Conclusions.-Although unusual, paroxysms in SUNCT may overlap into a clinical status. A strong relationship with hormonal changes was noted in one patient. In both cases, the pain was refractory to treatment with indomethacin, carbamazepine, and hypnotics, and only intravenous methylprednisolone with oral carbamazepine may have been partially effective in one case. Key words: SUNCT, unilateral headaches, steroids, carbamazepineAbbreviations: SUNCT short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing ( Headache 2001;41:826-829) In 1978, Sjaastad et al 1 described an entity termed SUNCT (short-lasting unilateral neuralgiform pain with conjunctival injection and tearing) characterized by recurrent, brief (15 to 120 seconds) unilateral pain attacks localized in the periocular area, with a rather abrupt onset and end, associated with marked ipsilateral autonomic features (massive conjunctival injection, watering of the eye, rhinorrhea, subclinical forehead sweating, and changes in cardiovascular variables). SUNCT has been classified among the trigeminal autonomic cephalgias and new diagnostic criteria have recently been proposed. 2,3 Generally, SUNCT starts around aged 51 years, with a range between 41 and 70 years for most cases. 4 Until 1994 when two women were reported, only men had been described. 5 The sex ratio for 25 reported cases is 2.57 men for every woman. 4 The frequency of attacks shows great variability not only between individuals but also in the same patient. The number of paroxysms may range from a few attacks per day to nearly continuous attacks, in what has been termed SUNCT status , which is an almost unbearable condition due to the intensity and frequency of the attacks. [6][7][8] We describe the statuslike pattern of the SUNCT syndrome in two young women. METHODSThe clinical notes of 254 patients with a diagnosis of cluster-type headache were reviewed. SUNCT was diagnosed when the patients had moderate to severe,

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome: a review

“…Attacks may be as infrequent as once daily or less to more than 60 per hour [12]. Objective assessment of the frequency of attacks in four patients demonstrated a mean of 16 attacks daily, with a range of 1 to 86 attacks daily [13].…”

“…The individual short-lasting attacks are brief, lasting between 2 and 600 seconds [7,11,12]. In addition, the authors observed a SUNCT patient for whom all of the attacks lasted between 8 and 20 minutes, thus extending the range of duration of short-lasting SUNCT attacks (Matharu et al, unpublished observations).…”

A patient with SUNCT syndrome responsive to sodium valproate

“…The area corresponding to the first branch of the trigeminal nerve is the most commonly reported, but other parts have been described as well [2,[6][7][8].…”

Intravenous Lidocaine and Mexiletine in the Management of Trigeminal Autonomic Cephalalgias

“…SUNCT or SUNA may occasionally present with statuslike exacerbations, with up to 60 attacks in an hour [4]. Occasionally, these patients will require hospitalization to control symptoms, which may prevent them from drinking or chewing.…”

“…Cluster headache (CH), shortlasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) are TACs that occasionally require emergency treatment. SUNCT and SUNA are especially refractory to treatment with acute analgesics, including opioids [2,3], and may present with status-like frequency, requiring urgent treatment [4,5]. Lidocaine and mexiletine are antiarrhythmic medications that appear safe and effective in the treatment of various pain disorders, including neuropathic pain.…”