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Jansem P, Watanapa N, Thanprasertsuk S, Rattanawong W, Pongpitakmetha T, Anukoolwittaya P. A SUNCT-like headache associated with lateral pontine infarction - case series and systematic review. Eur J Pain 2024. [PMID: 38476053 DOI: 10.1002/ejp.2261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/18/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND AND AIM Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and autonomic symptoms (SUNA) are trigeminal autonomic cephalalgias (TACs). The study explores the potential association between SUNCT/SUNA-like headaches and lateral pontine infarctions. METHODS Case series and systematic review. RESULTS We present three cases diagnosed with SUNCT following lateral pontine infarction on magnetic resonance imaging (MRI), along with a review of these cases and 10 others from the literature. DISCUSSION AND CONCLUSION This review suggests a connection between SUNCT/SUNA-like symptoms and lateral pontine infarctions. The section also delves into the anatomy and pathophysiology of these symptoms, proposing a mechanism involving neural pathway remodelling in the lateral brainstem.
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Affiliation(s)
- Priabprat Jansem
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nattapat Watanapa
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sekh Thanprasertsuk
- Chulalongkorn Headache and Orofacial Pain (CHOP) Service and Research Group, Chulalongkorn University, Bangkok, Thailand
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Wanakorn Rattanawong
- Chulalongkorn Headache and Orofacial Pain (CHOP) Service and Research Group, Chulalongkorn University, Bangkok, Thailand
- Department of Medicine, Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Thanakit Pongpitakmetha
- Chulalongkorn Headache and Orofacial Pain (CHOP) Service and Research Group, Chulalongkorn University, Bangkok, Thailand
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Prakit Anukoolwittaya
- Chulalongkorn Headache and Orofacial Pain (CHOP) Service and Research Group, Chulalongkorn University, Bangkok, Thailand
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Differential diagnosis short-lasting unilateral neuralgiform headache attacks and trigeminal neuralgia. КЛИНИЧЕСКАЯ ПРАКТИКА 2019. [DOI: 10.17816/clinpract10260-65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The article presents diagnostic criteria, comparative characteristics of short-lasting unilateral neuralgiform headache attacks, including short-term unilateral neuralgic headaches with conjunctival injection and lacrimation (SUNCT) and short-term unilateral neuralgic headaches with cranial autonomic symptoms (SUNA), differential diagnosis with trigeminal neuralgia.
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Baraldi C, Pellesi L, Guerzoni S, Cainazzo MM, Pini LA. Therapeutical approaches to paroxysmal hemicrania, hemicrania continua and short lasting unilateral neuralgiform headache attacks: a critical appraisal. J Headache Pain 2017; 18:71. [PMID: 28730562 PMCID: PMC5519518 DOI: 10.1186/s10194-017-0777-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/04/2017] [Indexed: 12/30/2022] Open
Abstract
Background Hemicrania continua (HC), paroxysmal hemicrania (PH) and short lasting neuralgiform headache attacks (SUNCT and SUNA) are rare syndromes with a difficult therapeutic approach. The aim of this review is to summarize all articles dealing with treatments for HC, PH, SUNCT and SUNA, comparing them in terms of effectiveness and safety. Methods A survey was performed using the pubmed database for documents published from the 1st January 1989 onwards. All types of articles were considered, those ones dealing with symptomatic cases and non-English written ones were excluded. Results Indomethacin is the best treatment both for HC and PH. For the acute treatment of HC, piroxicam and celecoxib have shown good results, whilst for the prolonged treatment celecoxib, topiramate and gabapentin are good options besides indomethacin. For PH the best drug besides indomethacin is piroxicam, both for acute and prolonged treatment. For SUNCT and SUNA the most effective treatments are intravenous or subcutaneous lidocaine for the acute treatment of active phases and lamotrigine for the their prevention. Other effective therapeutic options are intravenous steroids for acute treatment and topiramate for prolonged treatment. Non-pharmacological techniques have shown good results in SUNCT and SUNA but, since they have been tried on a small number of patients, the reliability of their efficacy is poor and their safety profile mostly unknown. Conclusions Besides a great number of treatments tried, HC, PH, SUNCT and SUNA management remains difficult, according with their unknown pathogenesis and their rarity, which strongly limits the studies upon these conditions. Further studies are needed to better define the treatment of choice for these conditions. Electronic supplementary material The online version of this article (doi:10.1186/s10194-017-0777-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlo Baraldi
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
| | - Lanfranco Pellesi
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Simona Guerzoni
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Maria Michela Cainazzo
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Luigi Alberto Pini
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
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Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate and explain our current understanding of a very rare disorder, long-lasting autonomic symptoms with associated hemicranias (LASH). RECENT FINDINGS At present, there are four known cases in the literature of LASH. Its characteristics and reported response to indomethacin link it most closely to the trigeminal autonomic cephalalgias (TACs). Its pathophysiology and epidemiology remain unclear. Variance in the pain and autonomic symptom relationship in the existing TAC literature along with the reports of TAC sine headache suggests that LASH may represent a far end of the spectrum of TACs, with most similarities to paroxysmal hemicrania (PH) and hemicrania continua (HC).
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Cohen A. SUN: Short-Lasting Unilateral Neuralgiform Headache Attacks. Headache 2017; 57:1010-1020. [PMID: 28474431 DOI: 10.1111/head.13088] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/20/2017] [Indexed: 01/03/2023]
Abstract
PREMISE Short-lasting unilateral neuralgiform headache attacks (SUN) are part of the group of primary headaches called trigeminal autonomic cephalalgias (TACs). They are characterized by unilateral attacks of pain with associated ipsilateral cranial autonomic symptoms. PROBLEM Recently the classification of these attacks has changed, to incorporate the different types of autonomic symptoms such as conjunctival injection and tearing (or lack thereof). Previously considered to be rare and rather refractory to treatment, there is an increasing awareness of this syndrome and the therapeutic possibilities. DISCUSSION This article discusses the clinical aspects of the syndrome, pathophysiology, current, and future treatments.
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Affiliation(s)
- Anna Cohen
- Royal Free Hospital, Clinical Neurosciences, London, United Kingdom
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Jacob S, Rajabally Y. Short-Lasting Unilateral Neuralgiform Headache with Cranial Autonomic Symptoms (SUNA) Following Vertebral Artery Dissection. Cephalalgia 2016; 27:283-5. [PMID: 17381562 DOI: 10.1111/j.1468-2982.2007.01286.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Jacob
- Department of Neurology, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
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Charleston L. Do Trigeminal Autonomic Cephalalgias Represent Primary Diagnoses or Points on a Continuum? Curr Pain Headache Rep 2015; 19:22. [DOI: 10.1007/s11916-015-0493-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Costa A, Antonaci F, Ramusino MC, Nappi G. The Neuropharmacology of Cluster Headache and other Trigeminal Autonomic Cephalalgias. Curr Neuropharmacol 2015; 13:304-23. [PMID: 26411963 PMCID: PMC4812802 DOI: 10.2174/1570159x13666150309233556] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 12/19/2014] [Accepted: 03/06/2015] [Indexed: 11/22/2022] Open
Abstract
Trigeminal autonomic cephalalgias (TACs) are a group of primary headaches including cluster headache (CH), paroxysmal hemicrania (PH) and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). Another form, hemicrania continua (HC), is also included this group due to its clinical and pathophysiological similarities. CH is the most common of these syndromes, the others being infrequent in the general population. The pathophysiology of the TACs has been partly elucidated by a number of recent neuroimaging studies, which implicate brain regions associated with nociception (pain matrix). In addition, the hypothalamic activation observed in the course of TAC attacks and the observed efficacy of hypothalamic neurostimulation in CH patients suggest that the hypothalamus is another key structure. Hypothalamic activation may indeed be involved in attack initiation, but it may also lead to a condition of central facilitation underlying the recurrence of pain episodes. The TACs share many pathophysiological features, but are characterised by differences in attack duration and frequency, and to some extent treatment response. Although alternative strategies for the TACs, especially CH, are now emerging (such as neurostimulation techniques), this review focuses on the available pharmacological treatments complying with the most recent guidelines. We discuss the clinical efficacy and tolerability of the currently used drugs. Due to the low frequency of most TACs, few randomised controlled trials have been conducted. The therapies of choice in CH continue to be the triptans and oxygen for acute treatment, and verapamil and lithium for prevention, but promising results have recently been obtained with novel modes of administration of the triptans and other agents, and several other treatments are currently under study. Indomethacin is extremely effective in PH and HC, while antiepileptic drugs (especially lamotrigine) appear to be increasingly useful in SUNCT. We highlight the need for appropriate studies investigating treatments for these rare, but lifelong and disabling conditions.
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Affiliation(s)
- Alfredo Costa
- National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, via Mondino 2, 27100 Pavia, Italy.
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Cruz S, Lemos C, Monteiro JMP. Familial aggregation of cluster headache. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 71:866-70. [PMID: 24394873 DOI: 10.1590/0004-282x20130170] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/07/2013] [Accepted: 06/14/2013] [Indexed: 11/21/2022]
Abstract
UNLABELLED Several studies suggest a strong familial aggregation for cluster headache (CH), but so far none of them have included subjects with probable cluster headache (PCH) in accordance with the International Classification of Headache Disorders. OBJECTIVE To identify cases of probable cluster headache and to assess the familial aggregation of cluster headache by including these subjects. METHOD Thirty-six patients attending a headache consultation and diagnosed with trigeminal autonomic headaches were subjected to a questionnaire-based interview. A telephone interview was also applied to all the relatives who were pointed out as possibly affected as well as to some of the remaining relatives. RESULTS Twenty-four probands fulfilled the criteria for CH or PCH; they had 142 first-degree relatives, of whom five were found to have CH or PCH, including one case of CH sine headache. The risk for first-degree relatives was observed to be increased by 35- to 46-fold. CONCLUSION Our results suggest a familial aggregation of cluster headache in the Portuguese population.
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Affiliation(s)
- Simão Cruz
- Serviço de Neurologia, Hospital Prof. Dr. Fernando Fonseca, Portugal, Sintra
| | - Carolina Lemos
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal
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Favoni V, Grimaldi D, Pierangeli G, Cortelli P, Cevoli S. SUNCT/SUNA and neurovascular compression: new cases and critical literature review. Cephalalgia 2013; 33:1337-48. [PMID: 23800827 DOI: 10.1177/0333102413494273] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with cranial autonomic symptoms (SUNA) are primary headache syndromes. A growing body of literature has focused on brain magnetic resonance imaging (MRI) evidence of neurovascular compression in these syndromes. OBJECTIVE The objective of this article is to assess whether SUNCT is a subset of SUNA or whether the two are separate syndromes and clarify the role of neurovascular compression. METHOD We describe three new SUNCT cases with MRI findings of neurovascular compression and critically review published SUNCT/SUNA cases. RESULTS We identified 222 published SUNCT/SUNA cases. Our three patients with neurovascular compression added to the 34 cases previously described (16.9%). SUNCT and SUNA share the same clinical features and therapeutic options. At present, there is no available abortive treatment for attacks. Lamotrigine was effective in 64% of patients; topiramate and gabapentin in about one-third of cases. Of the 34 cases with neurovascular compression, seven responded to drug therapies, 16 patients underwent microvascular decompression of the trigeminal nerve (MVD) with effectiveness in 75%. CONCLUSIONS We suggest that SUNCT and SUNA should be considered clinical phenotypes of the same syndrome. Brain MRI should always be performed with a dedicated view to exclude neurovascular compression. The high percentage of remission after MVD supports the pathogenetic role of neurovascular compression.
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Affiliation(s)
- Valentina Favoni
- IRCCS Institute of Neurological Sciences of Bologna, Headache Centre, Bologna, Italy
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Pareja JA, Álvarez M, Montojo T. SUNCT and SUNA: Recognition and Treatment. Curr Treat Options Neurol 2012; 15:28-39. [DOI: 10.1007/s11940-012-0211-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chitsantikul P, Becker WJ. SUNCT, SUNA and pituitary tumors: Clinical characteristics and treatment. Cephalalgia 2012. [DOI: 10.1177/0333102412468672] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) are rare types of trigeminal autonomic cephalalgias (TACs). Objective To describe a series of patients with SUNCT and SUNA including relationship to pituitary tumors. Method All patients diagnosed with SUNCT or SUNA in the Calgary Headache Assessment and Management Program were reviewed. Results Six patients (five SUNCTs and one SUNA) were identified. The pain was severe, sharp, showed fixed-laterality, involved mainly the orbito-fronto-temporal region and was associated with autonomic symptoms. Attack duration ranged from 3 to 300 seconds and frequency was 1–200 paroxysms/day. MRI showed ipsilateral pituitary adenomas to the pain in five out of five of the SUNCT patients. Patients with adenomas underwent surgery. Pathology included three prolactinomas, and one mixed adenoma and gangliocytoma. One patient has remained headache free for 4 years after surgery. One was pain free for a year, and then headaches returned with tumor recurrence. Another had major improvement, and two have not improved. Patients were generally refractory to medications. Conclusion All five of our patients with typical SUNCT had pituitary tumors, with headache ipsilateral to the pituitary tumors in all cases. Tumor removal provided major improvement in three out of five patients. Medical treatment was only partially effective.
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Affiliation(s)
- Prin Chitsantikul
- Department of Clinical Neurosciences, University of Calgary and Alberta Health Services, Canada
- Division of Neurology, Foothills Hospital, Canada
| | - Werner J Becker
- Department of Clinical Neurosciences, University of Calgary and Alberta Health Services, Canada
- Division of Neurology, Foothills Hospital, Canada
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Sarchielli P, Granella F, Prudenzano MP, Pini LA, Guidetti V, Bono G, Pinessi L, Alessandri M, Antonaci F, Fanciullacci M, Ferrari A, Guazzelli M, Nappi G, Sances G, Sandrini G, Savi L, Tassorelli C, Zanchin G. Italian guidelines for primary headaches: 2012 revised version. J Headache Pain 2012; 13 Suppl 2:S31-70. [PMID: 22581120 PMCID: PMC3350623 DOI: 10.1007/s10194-012-0437-6] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults was published in J Headache Pain 2(Suppl. 1):105–190 (2001). Ten years later, the guideline committee of the Italian Society for the Study of Headaches (SISC) decided it was time to update therapeutic guidelines. A literature search was carried out on Medline database, and all articles on primary headache treatments in English, German, French and Italian published from February 2001 to December 2011 were taken into account. Only randomized controlled trials (RCT) and meta-analyses were analysed for each drug. If RCT were lacking, open studies and case series were also examined. According to the previous edition, four levels of recommendation were defined on the basis of levels of evidence, scientific strength of evidence and clinical effectiveness. Recommendations for symptomatic and prophylactic treatment of migraine and cluster headache were therefore revised with respect to previous 2001 guidelines and a section was dedicated to non-pharmacological treatment. This article reports a summary of the revised version published in extenso in an Italian version.
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Affiliation(s)
- Paola Sarchielli
- Headache Centre, Neurologic Clinic, University of Perugia, Perugia, Italy.
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Abstract
Cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) are primary headaches recently classified together as trigeminal autonomic cephalalgias (TACs). The causes of these headaches have long been debated, with "peripheral" hypotheses in opposition to "central" hypotheses. The available information indicates that the pain originates from within the brain in cluster headache. The hypothalamic activation observed during TAC attacks by use of functional neuroimaging, and the success of hypothalamic stimulation as a treatment, confirm that the posterior hypothalamus is crucial in the pathophysiology of these headaches. The posterior hypothalamus is now known to modulate craniofacial pain, and hypothalamic activation occurs in other pain disorders, suggesting that this brain area is likely to have a more complex role in the pathophysiology of TACs than that of a mere trigger. Hypothalamic activation might play a part in terminating rather than triggering attacks, and might also give rise to a central permissive state, allowing attacks to take place.
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Alore PL, Jay WM, Macken MP. SUNCT Syndrome: Short-Lasting Unilateral Neuralgiform Headache with Conjunctival Injection and Tearing. Semin Ophthalmol 2009; 21:9-13. [PMID: 16517438 DOI: 10.1080/08820530500509317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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.
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De Cesaris F, Fanciullacci M, Pietrini U, Anselmi B, Del Bene E. Defining neuralgiform headache with ipsilateral autonomic symptoms: case report in a headache center. Intern Emerg Med 2008; 3:413-4. [PMID: 18566758 DOI: 10.1007/s11739-008-0168-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 05/26/2008] [Indexed: 10/21/2022]
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SUNCT and SUNA: Clinical features and medical treatment. J Clin Neurosci 2008; 15:526-34. [DOI: 10.1016/j.jocn.2006.09.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 09/12/2006] [Accepted: 09/12/2006] [Indexed: 11/23/2022]
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Lenaerts ME. Update on the therapy of the trigeminal autonomic cephalalgias. Curr Treat Options Neurol 2008; 10:30-5. [DOI: 10.1007/s11940-008-0004-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW The new International Classification of Headache Disorders was recently published by the International Headache Society. Several uncommon primary headaches, including some new clinical entities (e.g. hypnic headache), were included in the section on 'Cluster headache and other trigeminal autonomic neuralgias' and 'Other primary headaches'. The recent classification offers an interesting opportunity to evaluate the clinical role and to discuss the mechanisms of some of the more relevant uncommon primary headaches. RECENT FINDINGS Due to the low incidence of these uncommon headache forms, their diagnostic criteria, pathogenetic mechanisms and therapy are still debated. Differential diagnosis versus secondary headaches is also a crucial issue. In this review, some of the most important uncommon primary headaches are discussed in light of the most recent contributions to the literature. SUMMARY The review focuses on the update of the main uncommon primary headaches, intending to clarify some controversial points and to indicate some headlines for further research.
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Affiliation(s)
- Giorgio Sandrini
- University Center for Adaptive Disorders and Headache, IRCCS 'C. Mondino' Institute of Neurology Foundation, Pavia, Italy.
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Leone M, Mea E, Genco S, Bussone G. Coexistence of TACS and Trigeminal Neuralgia: Pathophysiological Conjectures. Headache 2006; 46:1565-70. [PMID: 17115989 DOI: 10.1111/j.1526-4610.2006.00537.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Trigeminal autonomic cephalgias (TACs) and trigeminal neuralgia are short-lasting unilateral primary headaches whose study is providing insights into craniofacial pain mechanisms. We report on 2 patients in whom trigeminal neuralgia coexists with the TACs paroxysmal hemicrania and SUNCT. CONCLUSION Coexistence of trigeminal neuralgia with various TAC forms suggests a pathophysiological relationship between these short-lasting unilateral headaches.
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Affiliation(s)
- Massimo Leone
- Departments of Neurology and Headache, Istituto Nazionale Neurologico Carlo Besta, Milano, Italy
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