SUNCT Syndrome: Short-Lasting Unilateral Neuralgiform Headache with Conjunctival Injection and Tearing

Abstract

The SUNCT syndrome refers to Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing. It is characterized by brief attacks of severe unilateral pain in the orbitotemporal region, associated with ipsilateral cranial autonomic disturbances. All SUNCT patients experience ipsilateral conjunctival injection and lacrimation. Mean age of onset is 50 years with a male predominance. The syndrome is often misdiagnosed as trigeminal neuralgia or cluster headache. Primary and secondary forms exist, the secondary form is most commonly associated with lesions of the posterior fossa or pituitary adenoma. The SUNCT syndrome is refractory to most commonly employed therapies. Lamotrigine has recently been reported as an effective first line therapy.

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

“…Mechanical trigger factors were reported by the patient and, they have also been described in SUNA (Short-lasting Unilateral Neuralgiform headache attacks with cranial Autonomic features) and SUNCT. [2,3,10] Unlike trigeminal neuralgia, in the present case the pain was present in the area of the first division of the trigeminal nerve and was accompanied by cranial autonomic symptoms. [1,10] Shorter duration of attacks differentiated it from cluster headache and paroxysmal hemicrania.…”

“…Contrary to the present report, most of the case reports in the past had described complete remission of SUNCT with lamotrigine monotherapy. [2][3][4] To achieve better control of symptoms in the present patient we decided to combine two anticonvulsants which is a common method for refractory cases of epilepsy and mania. It should be noted here that the combination of drugs is described to be more efficacious in controlling symptoms along with the minimization of dosedependent adverse effects.…”

“…Diagnosis of SUNCT was made and baseline investigations (complete blood counts and liver function tests) were ordered. Since lamotrigine had shown promising results in the management of SUNCT, [2][3][4][5]7] he was gradually shifted from carbamazepine 600 mg/day to lamotrigine 100 mg/day over four weeks. Further Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is characterized by short-lived, strictly unilateral, moderate to severe pain attacks in the orbital area and is accompanied by conjunctival injection and lacrimation.…”

“…[1] It can be primary or secondary; the latter being commonly associated with lesions of the posterior fossa or pituitary adenoma. [2] It is refractory to many of the commonly employed therapies but the patient may benefit from a variety of antiepileptics e.g. carbamazepine, topiramate, [3] lamotrigine, [2][3][4] gabapentin [3,5] and oxcarbazepine.…”

Trigeminal Neuralgia in Two Patients With Glioblastoma

“…Headache with features of SUNCT syndrome, although it usually presents as a primary condition, should be evaluated by neuroimaging studies, with several cases of symptomatic SUNCT syndrome having been described. 13,14 The majority of reported symptomatic cases had intracranial pathologies, including arteriovenous malformation or tumor in the cerebellopontine angle, 2-4 brainstem infarction, 5 basilar impression in association with osteogenesis imperfecta, 6 pituitary adenoma, 7 and parapontine cavernous angioma. 8 Therefore, neuroimaging studies are usually focused on intracranial structures related to the trigeminovascular system.…”