Tic, Triggering, and Tearing: From CTN to SUNHA

Benoliel, Rafael; Sharav, Yair; Haviv, Yaron; Almoznino, Galit

doi:10.1111/head.13040

Cited by 29 publications

(18 citation statements)

References 117 publications

(364 reference statements)

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“…2 Physical and neurologic examinations, laboratory investigations, brain MRI, and angio MRI were unremarkable. The uniqueness of the attack presentation lies in the simultaneous dystonic-like jaw opening.…”

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confidence: 97%

“…2 Physical and neurologic examinations, laboratory investigations, brain MRI, and angio MRI were unremarkable. Moreover, although facial muscles contractions can be observed during trigeminal neuralgia attacks (the so-called "tic-doloreux"), they are usually shorter in duration, with milder autonomic symptoms and the location of the pain (electric shock-like in quality) interest more frequently the second and/or third trigeminal branches.…”

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confidence: 97%

“…Moreover, although facial muscles contractions can be observed during trigeminal neuralgia attacks (the so-called "tic-doloreux"), they are usually shorter in duration, with milder autonomic symptoms and the location of the pain (electric shock-like in quality) interest more frequently the second and/or third trigeminal branches. 2 Physical and neurologic examinations, laboratory investigations, brain MRI, and angio MRI were unremarkable. The blink reflex test, in the interictal period, showed a contralateral delay of the later R2 response during stimulation of the right supraorbital nerve and a bilateral delay of the later R2 responses during stimulation of the left supraorbital nerve.…”

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confidence: 97%

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SUNCT‐Induced Jaw Opening: A Rare Trigeminal Autonomic Phenotype

et al. 2019

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Key words: short-lasting unilateral neuralgiform headache with conjunctival injection and tearing, trigeminal autonomic cephalalgia, blink reflex, headache (Headache 2020;60:476-477) We report the case of a 32-year-old man experiencing episodes of strictly unilateral, unbearable, stabbing pain involving the left orbitotemporal region, lasting about 60 seconds, associated with mild ipsilateral cranial autonomic features such as conjunctival injection, tearing, and nasal congestion. The uniqueness of the attack presentation lies in the simultaneous dystonic-like jaw opening. The patient attacks could be triggered by facial skin stimulation, chewing, or mandibular overstretching, and the patient was completely symptom-free during the interictal phase. The patient came to our attention 5 months after the onset of the attacks and had previously a neurologist who suspected a trigeminal neuralgia and started a therapy with carbamazepine up to a dose of 200 mg t.i.d. which did not result in any benefits.Although the reported episodes may fulfill the International Headache Society criteria for both trigeminal neuralgia and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), 1 the poor response to carbamazepine, the long attack duration, the presence of significant autonomic features, the pain quality, and localization made the diagnosis of trigeminal neuralgia unlikely. Moreover, although facial muscles contractions can be observed during trigeminal neuralgia attacks (the so-called "tic-doloreux"), they are usually shorter in duration, with milder autonomic symptoms and the location of the pain (electric shock-like in quality) interest more frequently the second and/or third trigeminal branches. 2 Physical and neurologic examinations, laboratory investigations, brain MRI, and angio MRI were unremarkable. The blink reflex test, in the interictal period, showed a contralateral delay of the later R2 response during stimulation of the right supraorbital nerve and a bilateral delay of the later R2 responses during stimulation of the left supraorbital nerve. These findings suggest an impairment of the Headache

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SUNCT‐Induced Jaw Opening: A Rare Trigeminal Autonomic Phenotype

et al. 2019

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“…This issue of Headache Currents contains two masterful clinical reviews on short‐lasting unilateral headache attacks by two of the leading experts on these disorders, Drs. Raphael Benoliel et al and Anna Cohen . The International Classification of Headache Disorders (ICHD‐3) Beta places the two previously proposed trigeminal autonomic cephalalgias (TACs), short‐lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short‐lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) under the rubric of short‐lasting unilateral headache attacks…”

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confidence: 99%

“…If so, this may reflect a spectrum of disease ranging from typical CTN attacks to typical SUNHAs with a mixed phenotype in the middle. In this review, we will summarize the overlap between these entities and contrast the pathophysiology and treatment approach.” Dr. Cohen also describes the differential diagnosis challenge in the section of her paper entitled, “SUNCT, SUNA, and Trigeminal Neuralgia.”…”

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confidence: 99%