1
|
Panda AK, Hazra S, Grover D. Excellent Response to Repeated Greater Occipital Nerve Blocks in a Patient with Short-Lasting Unilateral Neuralgiform Headache with Conjunctival Tearing. Ann Indian Acad Neurol 2024; 27:334-336. [PMID: 38819412 DOI: 10.4103/aian.aian_1104_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/22/2024] [Indexed: 06/01/2024] Open
Affiliation(s)
- Ashwin K Panda
- Department of Neurology, Institute of Human Behavior and Allied Sciences, Dilshad Garden, Delhi, India
| | | | | |
Collapse
|
2
|
Burish M. Cluster Headache, SUNCT, and SUNA. Continuum (Minneap Minn) 2024; 30:391-410. [PMID: 38568490 DOI: 10.1212/con.0000000000001411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE This article reviews the epidemiology, clinical features, differential diagnosis, pathophysiology, and management of three types of trigeminal autonomic cephalalgias: cluster headache (the most common), short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). LATEST DEVELOPMENTS The first-line treatments for trigeminal autonomic cephalalgias have not changed in recent years: cluster headache is managed with oxygen, triptans, and verapamil, and SUNCT and SUNA are managed with lamotrigine. However, new successful clinical trials of high-dose prednisone, high-dose galcanezumab, and occipital nerve stimulation provide additional options for patients with cluster headache. Furthermore, new genetic and imaging tests in patients with cluster headache hold promise for a better understanding of its pathophysiology. ESSENTIAL POINTS The trigeminal autonomic cephalalgias are a group of diseases that appear similar to each other and other headache disorders but have important differences. Proper diagnosis is crucial for proper treatment.
Collapse
|
3
|
Kang MK, Cho SJ. SUNCT, SUNA and short-lasting unilateral neuralgiform headache attacks: Debates and an update. Cephalalgia 2024; 44:3331024241232256. [PMID: 38415675 DOI: 10.1177/03331024241232256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Short-lasting unilateral neuralgiform headache attacks (SUNHA) have the features of both short-lasting unilateral neuralgiform pain, such as trigeminal neuralgia or stabbing headache, and associated trigeminal autonomic symptoms, such as paroxysmal hemicrania or cluster headache. Recognizing and adequately treating SUNHA is essential but current treatment methods are ineffective in treating SUNHA. METHODS We reviewed the changes in the concept of short-lasting unilateral neuralgiform headache attacks and provide a narrative review of the current medical and surgical treatment options, from the first choice of treatment for patients to treatments for selective intractable cases. RESULTS Unlike the initial impression of an intractable primary headache disorder affecting older men, SUNHA affects both sexes throughout their lifespan. One striking feature of SUNHA is that the attacks are triggered by cutaneous or intraoral stimulation. The efficacy of conventional treatments is disappointing and challenging, and preventive therapy is the mainstay of treatment because of highly frequent attacks of a very brief duration. Amongst them, lamotrigine is effective in approximately two-third of the patients with SUNHA, and intravenous lidocaine is essential for the management of acute exacerbation of intractable pain. Topiramate, oxcarbazepine and gabapentin are considered good secondary options for SUNHA, and botulinum toxin can be used in selective cases. Neurovascular compression is commonly observed in SUNHA, and surgical approaches, such as neurovascular compression, have been reported to be effective for intractable cases. CONCLUSIONS Recent advances in the understanding of SUNHA have improved the recognition and treatment approaches for this unique condition.
Collapse
Affiliation(s)
- Mi-Kyoung Kang
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| |
Collapse
|
4
|
Bhuvaneswaran R, Aghoram R. SUNCT, SUNA, and Trigeminal Neuralgia-Different Faces of the Same Disorder? Ann Indian Acad Neurol 2023; 26:626-627. [PMID: 38022449 PMCID: PMC10666873 DOI: 10.4103/aian.aian_737_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 12/01/2023] Open
|
5
|
Ghosh A, Varghese L, Burish MJ, Szperka CL. Trigeminal Autonomic Cephalalgias and Neuralgias in Children and Adolescents: a Narrative Review. Curr Neurol Neurosci Rep 2023; 23:539-549. [PMID: 37572226 DOI: 10.1007/s11910-023-01288-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE OF REVIEW To summarize the available literature as well as the authors' experience on trigeminal autonomic cephalalgias (TACs) and cranial neuralgias in children and adolescents. RECENT FINDINGS While TACs and cranial neuralgias are rare in children, several recent case series have been published. TACs in children share most of the clinical features of TACs in adults. However, there are many reported cases with clinical features which overlap more than one diagnosis, suggesting that TACs may be less differentiated in youth. Indomethacin-responsive cases of cluster headache and SUNCT/SUNA have been reported in children, whereas in adults indomethacin is usually reserved for paroxysmal hemicrania and hemicrania continua. Neuralgias appear to be rare in children. Clinical features are often similar to adult cases, though clinicians should maintain a high index of suspicion for underlying causes.
Collapse
Affiliation(s)
- Ankita Ghosh
- Division of Child Neurology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Leena Varghese
- Pediatric Headache Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark J Burish
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Christina L Szperka
- Pediatric Headache Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
6
|
Prakash S, Vadodaria V, Patel H, Rana K, Shah C. A Retrospective Comparative Study in Patients with SUNA and SUNCT. Ann Indian Acad Neurol 2023; 26:672-677. [PMID: 38022430 PMCID: PMC10666850 DOI: 10.4103/aian.aian_502_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/28/2023] [Accepted: 07/19/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction 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 primary headache disorders. Aim The aim of the study is to describe and compare the clinical characteristics of patients with SUNA and SUNCT. Methods Patients with SUNCT or SUNA observed in a neurology clinic of a tertiary hospital in India between January 2017 and December 2022 were evaluated. Results Thirteen patients with SUNA (seven female, 54%) and 16 patients with SUNCT (nine female, 56%) were identified for the evaluation. The mean ages at the onset of SUNA and SUNCT were 36.8.5 ± 8.1 years and 37.2 ± 8.4 years, respectively. The age of onset in our patients was somewhat younger than that of other large series. The demographic and clinical features of SUNA patients were comparable to those of SUNCT patients. Orbital/retro-orbital area was the most common site of pain in both types of headaches. The pattern of pain was noted as single stab (in all patients), repetitive stabs (SUNA vs. SUNCT: 77% vs. 75%), and sawtooth patterns (SUNA vs. SUNCT: 23% vs. 25%). The majority of attacks in both groups lasted less than two minutes. Conjunctival injection and tearing were present in all SUNCT patients (as a part of the diagnostic criteria). The prevalence of conjunctival injection and tearing in SUNA was 46% and 31%, respectively. All patients reported spontaneous attacks. Triggers were reported in seven (54%) patients with SUNA and nine (56%) with SUNCT. Only one patient in each group had a refractory period following a trigger-induced episode. Two patients in the SUNCT group had compression of the trigeminal nerve by a vascular loop. Conclusion This is the largest case series from India. There were no significant differences between patients with SUNA and SUNCT.
Collapse
Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara Gujarat, India
| | - Varoon Vadodaria
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara Gujarat, India
| | - Harsh Patel
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara Gujarat, India
| | - Kaushik Rana
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara Gujarat, India
| | - Chetsi Shah
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara Gujarat, India
| |
Collapse
|
7
|
A Case of SUNCT With Neurovascular Compression. J Neuroophthalmol 2022; 42:e593-e595. [PMID: 35482913 DOI: 10.1097/wno.0000000000001549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
8
|
Zhang S, Cao Y, Yan F, Chen S, Gui W, Hu D, Liu H, Li H, Yu R, Wei D, Wang X, Wang R, Chen X, Zhang M, Ran Y, Jia Z, Han X, He M, Liu J, Yu S, Dong Z. Similarities and differences between SUNCT and SUNA: a cross-sectional, multicentre study of 76 patients in China. J Headache Pain 2022; 23:137. [PMID: 36289482 PMCID: PMC9609258 DOI: 10.1186/s10194-022-01509-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/17/2022] [Indexed: 11/25/2022] Open
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) have not been evaluated sufficiently due to limited data, particularly in China. Methods Patients with SUNCT or SUNA treated in a tertiary headache centre or seven other headache clinics of China between April 2009 and July 2022 were studied; we compared their demographics and clinical phenotypes. Results The 45 patients with SUNCT and 31 patients with SUNA had mean ages at onset of 37.22 ± 14.54 years and 42.45 ± 14.72 years, respectively. The mean ages at diagnosis of SUNCT and SUNA were 41.62 ± 12.70 years and 48.68 ± 13.80 years, respectively (p = 0.024). The correct diagnosis of SUNCT or SUNA was made after an average of 2.5 (0–20.5) years or 3.0 (0–20.7) years, respectively. Both diseases had a female predominance (SUNCT: 1.14:1; SUNA: 2.10:1). The two diseases differed in the most common attack site (temporal area in SUNCT, p = 0.017; parietal area in SUNA, p = 0.002). Qualitative descriptions of the attacks included stabbing pain (44.7%), electric-shock-like pain (36.8%), shooting pain (25.0%), and slashing pain (18.4%). Lacrimation was the most common autonomic symptom in both SUNCT and SUNA patients, while eyelid oedema, ptosis, and miosis were less frequent. Triggers such as cold air and face washing were shared by the two diseases, and they were consistently ipsilateral to the attack site. Conclusions In contrast to Western countries, SUNCT and SUNA in China have a greater female predominance and an earlier onset. The shared core phenotype of SUNCT and SUNA, despite their partial differences, suggests that they are the same clinical entity.
Collapse
Affiliation(s)
- Shuhua Zhang
- grid.216938.70000 0000 9878 7032School of Medicine, Nankai University, Tianjin, 300071 China ,grid.414252.40000 0004 1761 8894Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Ya Cao
- grid.414252.40000 0004 1761 8894Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Fanhong Yan
- Department of Neurology, Linyi Jinluo Hospital, Linyi, Shandong China
| | - Sufen Chen
- grid.452210.0Department of Neurology, Changsha Central Hospital Affiliated to University of South China, Changsha, Hunan China
| | - Wei Gui
- grid.59053.3a0000000121679639Department of Neurology, The First Affiliated Hospital of USTC, Hefei, Anhui China
| | - Dongmei Hu
- grid.410638.80000 0000 8910 6733Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong China
| | - Huanxian Liu
- grid.414252.40000 0004 1761 8894Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Hongjin Li
- Department of Neurology, Dong E Hospital, Liaocheng, Shandong China
| | - Rongce Yu
- Department of Neurology, People’s Hospital of Luanchuan, Luoyang, Henan China
| | - Dan Wei
- grid.410609.aDepartment of Neurology, Wuhan No.1 Hospital of China Hubei Province, Wuhan, Hubei China
| | - Xiaolin Wang
- grid.414252.40000 0004 1761 8894Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Rongfei Wang
- grid.414252.40000 0004 1761 8894Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Xiaoyan Chen
- grid.414252.40000 0004 1761 8894Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Mingjie Zhang
- grid.414252.40000 0004 1761 8894Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Ye Ran
- grid.414252.40000 0004 1761 8894Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Zhihua Jia
- grid.414252.40000 0004 1761 8894Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Xun Han
- grid.414252.40000 0004 1761 8894Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Mianwang He
- grid.414252.40000 0004 1761 8894Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Jing Liu
- grid.414252.40000 0004 1761 8894Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Shengyuan Yu
- grid.216938.70000 0000 9878 7032School of Medicine, Nankai University, Tianjin, 300071 China ,grid.414252.40000 0004 1761 8894Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Zhao Dong
- grid.216938.70000 0000 9878 7032School of Medicine, Nankai University, Tianjin, 300071 China ,grid.414252.40000 0004 1761 8894Department of Neurology, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, 100853 China
| |
Collapse
|
9
|
Krishna Kumar V, Nair PP, Sree Deepthi GN, Pradeep Kumar PP. A case report on probable short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing following vairechanika nasya in Ménière's disease. J Ayurveda Integr Med 2021; 13:100532. [PMID: 34969589 PMCID: PMC8728096 DOI: 10.1016/j.jaim.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022] Open
Abstract
A 62 year old woman diagnosed with Ménière's disease, who underwent vairechanika nasya (VN) with shadbindu taila presented with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) like phenomena immediately after the procedure. Rescue measures of abhyanga (local oil massage) and nadi sweda (local fomentation) were administered. Within half an hour the symptoms considerably declined and after 1 hour got completely relieved. The exact symptom disclosure by the patient who herself was a doctor helped in detecting the classic pattern of ‘saw tooth phenomena’ giving leads into a rare manifestation of probable SUNCT. Naranjo scale yielded zero score and thus the probable causality of VN with shadbindu taila could not be established so as to cause probable SUNCT as an adverse drug reaction (ADR). This case study is not put up for reporting an ADR of VN with shadbindu taila; rather this illustrates an uncommon, yet imperative adverse event of probable SUNCT while undergoing nasya procedure probably due to judgment error while fixing the VN dose in a patient with Ménière's disease. Transparent reporting of such unusual events during panchakarma procedures is necessary so that clinicians can understand, evaluate and take appropriate initiatives to manage them.
Collapse
Affiliation(s)
- V Krishna Kumar
- Research Officers at National Ayurveda Research Institute for Panchakarma, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Govt. of India, Cheruthuruthy, India.
| | - Pratibha P Nair
- Research Officers at National Ayurveda Research Institute for Panchakarma, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Govt. of India, Cheruthuruthy, India
| | - G N Sree Deepthi
- Research Officers at National Ayurveda Research Institute for Panchakarma, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Govt. of India, Cheruthuruthy, India
| | - P P Pradeep Kumar
- Research Officers at National Ayurveda Research Institute for Panchakarma, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Govt. of India, Cheruthuruthy, India
| |
Collapse
|
10
|
SUNCT/SUNA in Pediatric Age: A Review of Pathophysiology and Therapeutic Options. Brain Sci 2021; 11:brainsci11091252. [PMID: 34573272 PMCID: PMC8466007 DOI: 10.3390/brainsci11091252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 12/27/2022] Open
Abstract
The International Classification of Headache Disorders, 3rd edition (ICHD3) defines Short-lasting Unilateral Neuralgiform Headache Attacks (SUNHA) as attacks of moderate or severe, strictly unilateral head pain lasting from seconds to minutes, occurring at least once a day and usually associated with prominent lacrimation and redness of the ipsilateral eye. Two subtypes of SUNHA are identified: Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT) and Short-lasting Unilateral Neuralgiform headache attacks with cranial Autonomic symptoms (SUNA). These pathologies are infrequent in children and difficult to diagnose. The authors reviewed the existing literature on SUNCT and SUNA, especially in the developmental age, which describes the pathophysiology in detail and focuses on the therapeutic options available to date. SUNHA-type headaches must be considered on the one hand, for the possibility of the onset of forms secondary to underlying pathologies even of a neoplastic nature, and on the other hand, for the negative impact they can have on an individual’s quality of life, particularly in young patients. Until now, published cases suggest that no chronic variants occur in childhood and adolescents. In light of this evidence, the authors offer a review that may serve as a source to be drawn upon in the implementation of suitable treatments in children and adolescents suffering from these headaches, focusing on therapies that are non-invasive and as risk-free as possible for pediatric patients.
Collapse
|
11
|
Abstract
Background Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA) are rare and disabling primary headache disorders that are subtypes of Short-lasting unilateral neuralgiform headache attacks (SUNHA). Aim The aim of this narrative review was to provide a comprehensive update on headache phenotype, pathophysiology, and various treatment options available for SUNCT and SUNA. Methods References for this review were identified by searches of articles published in the English language in PubMed between 1978 and October 2020 using "short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)", "short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA)", "short-lasting unilateral neuralgiform headache attacks (SUNHA)", "trigeminal autonomic cephalalgias" as keywords in various combinations. Results Of a potential 1103 articles, seven case series describing clinical characteristics of SUNCT/SUNA patients were identified for this review. For symptomatic/secondary SUNCT/SUNA, 53 individual case reports, and one case series were reviewed. One placebo-controlled trial and 11 open-label case series that evaluated various medical and surgical treatments in SUNCT/SUNA were also reviewed. Available literature suggests that SUNCT and SUNA are subtypes of the same disorder characterized by severe side locked short duration headache with ipsilateral prominent cranial autonomic symptoms and signs. Pathophysiology may involve both peripheral and central mechanisms. Lamotrigine is the most effective preventive therapy while intravenous lidocaine is the most efficacious drug as transitional therapy for severe disabling attacks. Surgical options including microvascular decompression in those having neurovascular conflict, occipital nerve stimulation, and hypothalamic deep brain stimulation can be alternative treatment options for medically refractory patients.
Collapse
Affiliation(s)
- Ashish K Duggal
- Department of Neurology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Debashish Chowdhury
- Department of Neurology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| |
Collapse
|
12
|
Lambru G, Rantell K, O'Connor E, Levy A, Davagnanam I, Zrinzo L, Matharu M. Trigeminal neurovascular contact in SUNCT and SUNA: a cross-sectional magnetic resonance study. Brain 2021; 143:3619-3628. [PMID: 33301567 PMCID: PMC7807031 DOI: 10.1093/brain/awaa331] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/21/2020] [Accepted: 08/06/2020] [Indexed: 01/03/2023] Open
Abstract
Emerging data-points towards a possible aetiological and therapeutic relevance of trigeminal neurovascular contact in short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and perhaps in short lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). We aimed to assess the prevalence and significance of trigeminal neurovascular contact in a large cohort of consecutive SUNCT and SUNA patients and evaluate the radiological differences between them. The standard imaging protocol included high spatial and nerve-cistern contrast resolution imaging acquisitions of the cisternal segments of the trigeminal nerves and vessels. MRI studies were evaluated blindly by two expert evaluators and graded according to the presence, location and degree of neurovascular contact. The degree of contact was graded as with or without morphological changes. Neurovascular contact with morphological changes was defined as contact with distortion and/or atrophy. A total of 159 patients (SUNCT = 80; SUNA = 79) were included. A total of 165 symptomatic and 153 asymptomatic trigeminal nerves were analysed. The proportion of neurovascular contact on the symptomatic trigeminal nerves was higher (80.0%) compared to the asymptomatic trigeminal nerves (56.9%). The odds on having neurovascular contact over the symptomatic nerves was significantly higher than on the asymptomatic nerves [odds ratio (OR): 3.03, 95% confidence interval (CI) 1.84–4.99; P < 0.0001]. Neurovascular contact with morphological changes were considerably more prevalent on the symptomatic side (61.4%), compared to the asymptomatic side (31.0%) (OR 4.16, 95% CI 2.46–7.05; P < 0.0001). On symptomatic nerves, neurovascular contact with morphological changes was caused by an artery in 95.0% (n = 77/81). Moreover, the site of contact and the point of contact around the trigeminal root were respectively proximal in 82.7% (67/81) and superior in 59.3% (48/81). No significant radiological differences emerged between SUNCT and SUNA. The multivariate analysis of radiological predictors associated with the symptomatic side, indicated that the presence of neurovascular contact with morphological changes was strongly associated with the side of the pain (OR: 2.80, 95% CI 1.44–5.44; P = 0.002) even when adjusted for diagnoses. Our findings suggest that neurovascular contact with morphological changes is involved in the aetiology of SUNCT and SUNA. Along with a similar clinical phenotype, SUNCT and SUNA also display a similar structural neuroimaging profile, providing further support for the concept that the separation between them should be abandoned. Furthermore, these findings suggest that vascular compression of the trigeminal sensory root, may be a common aetiological factor between SUNCT, SUNA and trigeminal neuralgia thereby further expanding the overlap between these disorders.
Collapse
Affiliation(s)
- Giorgio Lambru
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Khadija Rantell
- Biostatistician, Education Unit, UCL Queen Square Institute of Neurology, London UK
| | - Emer O'Connor
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrew Levy
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Functional Neurosurgery Unit, Department of Clinical and Motor Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| |
Collapse
|
13
|
Groenke BR, Daline IH, Nixdorf DR. SUNCT/SUNA: Case series presenting in an orofacial pain clinic. Cephalalgia 2020; 41:665-676. [PMID: 33269943 DOI: 10.1177/0333102420977292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Little is known about short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). We present our experience with SUNCT/SUNA patients to aid identification and management of these disorders. METHODS A retrospective review of patient records of one orofacial pain clinic was performed. Inclusion criteria was a diagnosis of SUNCT/SUNA confirmed with at least one follow-up visit. RESULTS Six of the 2464 new patients seen between 2015-2018 met the selection criteria (SUNCT n = 2, SUNA n = 4). Gender distribution was one male to one female and average age of diagnosis was 52 years (range 26-62). Attacks were located in the V1/V2 trigeminal distributions, and five patients reported associated intraoral pain. Pain quality was sharp, shooting, and burning with two patients reporting "numbness". Pain was moderate-severe in intensity, with daily episodes that typically lasted for seconds. Common autonomic features were lacrimation, conjunctival injection, rhinorrhea, and flushing. Frequent triggers were touching the nose or a specific intraoral area. Lamotrigine and gabapentin were commonly used as initial therapy. CONCLUSIONS Differentiating between SUNCT/SUNA does not appear to be clinically relevant. Presenting symptoms were consistent with those published, except 5/6 patients describing intraoral pain and two patients describing paresthesia.
Collapse
Affiliation(s)
- Beth R Groenke
- Division of TMD & Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Iryna Hryvenko Daline
- Division of TMD & Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Donald R Nixdorf
- Division of TMD & Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, USA.,Department of Radiology, Medical School, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
14
|
Stubberud A, Tronvik E, Matharu M. Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-00649-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract
Purpose of Review
This review presents a critical appraisal of the treatment strategies for short-lasting unilateral neuralgiform headache attacks (SUNHA), paroxysmal hemicrania (PH), and hemicrania continua (HC). We assess the available, though sparse, evidence on both medical and surgical treatments. In addition, we present estimated pooled analyses of the most common treatments and emphasize recent promising findings.
Recent Findings
The majority of literature available on the treatment of these rare trigeminal autonomic cephalalgias are small open-label observational studies and case reports. Pooled analyses reveal that lamotrigine for SUNHA and indomethacin for PH and HC are the preventative treatments of choice. Second-line choices include topiramate, gabapentin, and carbamazepine for SUNHA; verapamil for PH; and cyclooxygenase-2 inhibitors and gabapentin for HC. Parenteral lidocaine is highly effective as a transitional treatment for SUNHA. Novel therapeutic strategies such as non-invasive neurostimulation, targeted nerve and ganglion blockades, and invasive neurostimulation, including implanted occipital nerve stimulators and deep brain stimulation, appears to be promising options.
Summary
At present, lamotrigine as a prophylactic and parenteral lidocaine as transitional treatment remain the therapies of choice for SUNHA. While, by definition, both PH and CH respond exquisitely to indomethacin, evidence for other prophylactics is less convincing. Evidence for the novel emerging therapies is limited, though promising.
Collapse
|
15
|
Van Deun L, de Witte M, Goessens T, Halewyck S, Ketelaer MC, Matic M, Moens M, Vaes P, Van Lint M, Versijpt J. Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach. Eur Neurol 2020; 83:5-16. [PMID: 32222701 DOI: 10.1159/000505727] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/01/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Facial pain, alone or combined with other symptoms, is a frequent complaint. Moreover, it is a symptom situated at, more than any other pain condition, a crosspoint where several disciplines meet, for example, dentists; manual therapists; ophthalmologists; psychologists; and ear-nose-throat, pain, and internal medicine physicians besides neurologists and neurosurgeons. Recently, a new version of the most widely used classification system among neurologists for headache and facial pain, the International Classification of Headache Disorders, has been published. OBJECTIVE The aims of this study were to provide an overview of the most prevalent etiologies of facial pain and to provide a generic framework for the neurologist on how to manage patients presenting with facial pain. METHODS An overview of the different etiologies of facial pain is provided from the viewpoint of the respective clinical specialties that are confronted with facial pain. Key message: Caregivers should "think outside their own box" and refer to other disciplines when indicated. If not, a correct diagnosis can be delayed and unnecessary treatments might be given. The presented framework is aimed at excluding life- or organ-threatening diseases, providing several clinical clues and indications for technical investigations, and ultimately leading to the correct diagnosis and/or referral to other disciplines.
Collapse
Affiliation(s)
- Laura Van Deun
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Muriel de Witte
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Clinical Psychology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Thaïs Goessens
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Clinical Psychology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Stijn Halewyck
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Otorhinolaryngology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Marie-Christine Ketelaer
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium
| | - Milica Matic
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Anesthesiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Maarten Moens
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Neurosurgery, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Peter Vaes
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Manual Therapy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Michel Van Lint
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium.,Department of Ophthalmology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Jan Versijpt
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Headache and Facial Pain Clinic, Brussels, Belgium, .,Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium,
| |
Collapse
|
16
|
Verma R, Sarkar S, Mahapatro S. Short lasting unilateral neuralgiform headache with conjunctival injection and tearing as a presenting manifestation of contralateral cerebellopontine angle tumor. Neurol India 2020; 68:515-517. [DOI: 10.4103/0028-3886.284366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
17
|
|
18
|
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.
Collapse
|
19
|
Kikui S, Miyahara J, Sugiyama H, Yamakawa K, Kashiwaya Y, Ishizaki K, Danno D, Takeshima T. Clinical profile of SUNCT/SUNA in Japan: A clinic-based study. CEPHALALGIA REPORTS 2019. [DOI: 10.1177/2515816319829907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: This study aimed to report the clinical profiles of patients with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short-lasting unilateral neuralgiform headache attacks with cranial autonomic (SUNA) in a Japanese population by surveying those enrolled at a regional headache center in Japan. Methods: In this consecutive case series study, the clinical characteristics of patients with SUNCT (eight men, three women; mean age: 59.5 ± 20.5 years) and SUNA (five men, four women; mean age: 51.3 ± 18.4 years) who visited Tominaga Hospital from February 2011 to January 2017 were examined. Headaches were diagnosed according to the International Classification of Headache Disorders, Third edition (ICHD-3) guidelines. Results: Brief clusters of separate attacks were reported by all patients. The mean duration of attacks was 91.9 ± 87.9 s. Ipsilateral rhinorrhea was observed in 9 of 20 (45.0%) cases and facial sweating was observed in 1 of 20 (5.0%) cases. An eminent response to lamotrigine was observed in 9 of 9 (100%) patients; however, adverse events were only reported in 2 of 9 (22.2%) cases. An intravenous infusion of lidocaine was demonstrated to be completely successful for short-term prevention in 5 of 6 (83.3%) SUNCT cases. Conclusions: Lamotrigine can successfully treat most patients, and intravenous lidocaine is useful for the short-term preventive therapy of severe recalcitrant attacks in Japanese patients with SUNCT/SUNA.
Collapse
Affiliation(s)
- Shoji Kikui
- Headache Center, Department of Neurology, Tominaga Hospital, Osaka, Japan
| | - Junichi Miyahara
- Headache Center, Department of Neurology, Tominaga Hospital, Osaka, Japan
| | - Hanako Sugiyama
- Headache Center, Department of Neurology, Tominaga Hospital, Osaka, Japan
| | - Kentaro Yamakawa
- Headache Center, Department of Neurology, Tominaga Hospital, Osaka, Japan
| | | | - Kumiko Ishizaki
- Department of Rehabilitation, Kaikoukai Rehabilitation Hospital, Yatomi, Japan
| | - Daisuke Danno
- Headache Center, Department of Neurology, Tominaga Hospital, Osaka, Japan
| | - Takao Takeshima
- Headache Center, Department of Neurology, Tominaga Hospital, Osaka, Japan
| |
Collapse
|
20
|
Sardoeira A, Cação G, Pina S, Sousa AP, Damásio J. An unusual case of short-lasting unilateral neuralgiform headache attacks. Cephalalgia 2018; 39:674-677. [PMID: 30482045 DOI: 10.1177/0333102418815652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Short-lasting unilateral neuralgiform headaches include those with conjunctival injection and tearing and with cranial autonomic symptoms. Most frequently reported as idiopathic, there is a growing number of symptomatic cases described. CASE REPORT A 57-year old man presented a 16-year history of right hemifacial short-lasting pain attacks accompanied by ipsilateral autonomic symptoms and simultaneous malar contractions. Brain MRI disclosed a right acoustic neuroma compressing the right facial nerve and a venous developmental anomaly perpendicular to the right facial nerve root entry zone, without lesions affecting the trigeminal nerve. He was started on lamotrigine, resulting in complete remission of pain attacks, autonomic signs and facial contractions. CONCLUSIONS This patient presents a typical short-lasting unilateral neuralgiform headache with response to lamotrigine. The uniqueness of the case is the co-occurring malar contractions, evocative of facial nerve involvement. We speculate whether facial nerve compression renders this nerve more susceptible to triggering during a short-lasting unilateral neuralgiform headache attack.
Collapse
Affiliation(s)
- Ana Sardoeira
- 1 Neurology Department, Hospital de Santo António, CHP - Centro Hospitalar do Porto, Porto, Portugal
| | - Gonçalo Cação
- 1 Neurology Department, Hospital de Santo António, CHP - Centro Hospitalar do Porto, Porto, Portugal
| | - Sofia Pina
- 2 Neuroradiology Department, Hospital de Santo António, CHP - Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Paula Sousa
- 3 Neurophysiology Department, Hospital de Santo António, CHP - Centro Hospitalar do Porto, Portugal
| | - Joana Damásio
- 1 Neurology Department, Hospital de Santo António, CHP - Centro Hospitalar do Porto, Porto, Portugal
| |
Collapse
|
21
|
Abstract
The primary headaches are composed of multiple entities that cause episodic and chronic head pain in the absence of an underlying pathologic process, disease, or traumatic injury. The most common of these are migraine, tension-type headache, and the trigeminal autonomic cephalalgias. This article reviews the clinical presentation, pathophysiology, and treatment of each to help in differential diagnosis. These headache types share many common signs and symptoms, thus a clear understanding of each helps prevent a delay in diagnosis and inappropriate or ineffective treatment. Many of these patients seek dental care because orofacial pain is a common presenting symptom.
Collapse
Affiliation(s)
- Robert W Mier
- Tufts University School of Dental Medicine, 1 Kneeland Street, Suite 601, Boston, MA 02111, USA.
| | - Shuchi Dhadwal
- Tufts University School of Dental Medicine, 1 Kneeland Street, Suite 601, Boston, MA 02111, USA
| |
Collapse
|
22
|
|
23
|
Cao Y, Yang F, Dong Z, Huang X, Cao B, Yu S. Secondary Short-Lasting Unilateral Neuralgiform Headache with Conjunctival Injection and Tearing: A New Case and a Literature Review. J Clin Neurol 2018; 14:433-443. [PMID: 29856156 PMCID: PMC6172493 DOI: 10.3988/jcn.2018.14.4.433] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/11/2018] [Accepted: 03/12/2018] [Indexed: 01/03/2023] Open
Abstract
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a primary headache syndrome with an unclear pathogenesis. However, there is increasing evidence in the literature for secondary SUNCT being attributable to certain known lesions. We explored the possible neurobiological mechanism underlying SUNCT based on all reported cases of secondary SUNCT for which detailed information is available. Here we report a case of neuromyelitis optica spectrum disorders that had typical symptoms of SUNCT that might have been attributable to involvement of the spinal nucleus of the trigeminal nerve. We also review cases of secondary SUNCT reported in the English-language literature and analyze them for demographic characteristics, clinical features, response to treatment, and imaging findings. The literature review shows that secondary SUNCT can derive from a neoplasm, vascular disease, trauma, infection, inflammation, or congenital malformation. The pons with involvement of the trigeminal root entry zone was the most commonly affected region for inducing secondary SUNCT. In conclusion, the neurobiology of secondary SUNCT includes structures such as the nucleus and the trigeminal nerve with its branches, suggesting that some cases of primary SUNCT have underlying mechanisms that are related to existing focal damage that cannot be visualized.
Collapse
Affiliation(s)
- Ya Cao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Fei Yang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Zhao Dong
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xusheng Huang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Bingzhen Cao
- Department of Neurology, General Hospital of Jinan Military Command, Jinan, China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.
| |
Collapse
|
24
|
Antonaci F, Fredriksen T, Pareja JA, Sjaastad O. Shortlasting, Unilateral, Neuralgiform, Headache Attacks With Conjunctival Injection, Tearing, Sweating and Rhinorrhea: The Term and New View Points. Front Neurol 2018; 9:262. [PMID: 29740387 PMCID: PMC5924796 DOI: 10.3389/fneur.2018.00262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/04/2018] [Indexed: 01/03/2023] Open
Abstract
A solitary patient with symptoms similar to those of shortlasting unilateral neuralgiform conjunctival injection and tearing Short lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection, Tearing, sweating and rhinorrhoea (SUNCT) was first mentioned in 1978. The term SUNCT was first used in 1991. SUNCT is an acronym; the “S” signifies “Shortlasting”; the “U” symbolizes “Unilateral”; “N” stands for “Neuralgiform”; the “C” for “Conjunctival injection”; and “T” for “Tearing.” The term short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms were marketed in 2004. The terminology and new view points are discussed and nosography proposal for SUNCT is presented.
Collapse
Affiliation(s)
- Fabio Antonaci
- Department of Brain and Behavioral Sciences, C. Mondino National Institute of Neurology Foundation, IRCCS, University of Pavia, Pavia, Italy
| | - Torbjørn Fredriksen
- Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospitals, Trondheim, Norway
| | - Juan A Pareja
- Department of Neurology, University Hospital Fundación Alcorcón, Madrid, Spain
| | - Ottar Sjaastad
- Department of Neurology, St. Olavs Hospital, Trondheim University Hospitals, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
25
|
Abstract
Short-lasting unilateral neuralgiform headache attacks (SUNHA) is characterized by strictly unilateral trigeminal distribution pain that occurs in association with ipsilateral cranial autonomic features. There are two subtypes: short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). These disorders are rare but highly disabling. The management of SUNHA can be challenging. The abortive therapies are not generally useful as the attacks are relatively short-lasting. A myriad of pharmacological preventive treatments has been tried in single case reports or small series in an open-label fashion. Lamotrigine, as an oral preventive treatment, and lidocaine, as an intravenous transitional treatment, seems to be the most effective therapies. For medically intractable SUNHA, several surgical approaches have been tried. These include ablative procedures involving the trigeminal nerve or the Gasserian ganglion, microvascular decompression (MVD) of the trigeminal nerve, and neurostimulation techniques. MVD, occipital nerve stimulation, and ventral tegmental area deep brain stimulation have all been found to be effective in open-label series with relatively high-response rates. There is a considerable clinical, therapeutic, and radiological overlap between SUNCT, SUNA, and trigeminal neuralgia (TN). Despite being considered distinct conditions, the emerging evidence suggests a broader nosological concept of SUNCT, SUNA, and TN; these conditions may constitute a continuum of the same disorder, rather than separate clinical entities. Consideration needs to be given to classifying SUNHA with TN as a cranial neuralgia rather than as a trigeminal autonomic cephalalgia.
Collapse
Affiliation(s)
- Andrew Levy
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Manjit S. Matharu
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| |
Collapse
|
26
|
Abstract
Primary trigeminal autonomic cephalalgias (TACs) are uncommon group of headache disorders. These are defined and diagnosed by the criteria given by the International Classification of Headache Disorders 3β version. Over the past few decades, a number of secondary (symptomatic) cases have been described in the literature with headache features indistinguishable from primary TACs. Many structural and other pathologies have been found in these patients that can be causally related to the headaches. This review attempts to critically analyze the existing literature including the new cases published during 2015–2017.
Collapse
Affiliation(s)
- Debashish Chowdhury
- Department of Neurology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| |
Collapse
|
27
|
Biesbroek JM, Rutgers DR, van Gulik S, Frijns CJM. Short-lasting unilateral neuralgiform headache with autonomic symptoms associated with idiopathic hypertrophic pachymeningitis. CEPHALALGIA REPORTS 2018. [DOI: 10.1177/2515816318790546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA) is a rare form of trigeminal autonomic cephalalgia. SUNA is frequently associated with a trigeminal neurovascular conflict and rarely occurs secondary to other intracranial pathology. We report a patient with SUNA that was associated with ipsilateral meningeal inflammation caused by idiopathic hypertrophic pachymeningitis (HP). During the 9-year follow-up, she experienced multiple episodes of SUNA, most of which occurred during exacerbations of the pachymeningitis. This is the third case of SUNA associated with HP reported in the literature. Based on this observation, we suggest that in patients presenting with SUNA, besides dedicated magnetic resonance imaging (MRI) of the trigeminal nerve, gadolinium-enhanced brain MRI should be performed to rule out HP.
Collapse
Affiliation(s)
- J Matthijs Biesbroek
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dirk R Rutgers
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sander van Gulik
- Department of Neurology, Meander Medisch Centrum, Amersfoort, the Netherlands
| | - Catherina JM Frijns
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
28
|
Hassan S, Lagrata S, Levy A, Matharu M, Zrinzo L. Microvascular decompression or neuromodulation in patients with SUNCT and trigeminal neurovascular conflict? Cephalalgia 2017; 38:393-398. [DOI: 10.1177/0333102417735847] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives To assess the effectiveness of neuromodulation and trigeminal microvascular decompression (MVD) in patients with medically-intractable short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). Methods Two patients with medically refractory SUNCT underwent MVD following beneficial but incomplete response to neuromodulation (occipital nerve stimulation and deep brain stimulation). MRI confirmed neurovascular conflict with the ipsilateral trigeminal nerve in both patients. Results Although neuromodulation provided significant benefit, it did not deliver complete relief from pain and management required numerous postoperative visits with adjustment of medication and stimulation parameters. Conversely, MVD was successful in eliminating symptoms of SUNCT in both patients with no need for further medical treatment or neuromodulation. Conclusion Neuromodulation requires expensive hardware and lifelong follow-up and maintenance. These case reports highlight that microvascular decompression may be preferable to neuromodulation in the subset of SUNCT patients with ipsilateral neurovascular conflict.
Collapse
Affiliation(s)
- Samih Hassan
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Susie Lagrata
- Headache Group, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrew Levy
- Headache Group, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Manjit Matharu
- Headache Group, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, London, UK
| |
Collapse
|
29
|
Barloese MCJ. The pathophysiology of the trigeminal autonomic cephalalgias, with clinical implications. Clin Auton Res 2017; 28:315-324. [DOI: 10.1007/s10286-017-0468-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 09/11/2017] [Indexed: 01/03/2023]
|
30
|
Wöber C. Tics in TACs: A Step into an Avalanche? Systematic Literature Review and Conclusions. Headache 2017; 57:1635-1647. [PMID: 28542727 DOI: 10.1111/head.13099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Trigeminal autonomic cephalalgias (TACs) comprise cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua. In some cases, trigeminal neuralgia (TN, "tic douloureux") or TN-like pain may co-occur with TACs. AIM This article will review the co-occurrence and overlap of TACs and tics in order to contribute to a better understanding of the issue and an improved management of the patients. METHODS For performing a systematic literature review Pubmed was searched using a total of ten terms. The articles identified were screened for further articles of relevance. SUMMARY TACs are related to tics in various ways. TN or TN-like paroxysms may co-occur with CH, PH, and HC, labeled as cluster-tic syndrome, PH-tic syndrome, and HC-tic syndrome. Such co-occurrence was not only found in the primary TACs but also in secondary headaches resembling TACs. The initial onset of TAC and tic may be simultaneous or separated by months or years. In acute attacks, tic and TAC may occur concurrently or much more often independently of each other. The term "cluster-tic syndrome" was also used in patients with a single type of pain in a twilight zone between TACs and TN fulfilling none of the relevant diagnostic criteria. Short-lasting neuralgiform headache attacks overlap with TN in terms of clinical features, imaging findings, and therapy.
Collapse
Affiliation(s)
- Christian Wöber
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
31
|
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.
Collapse
Affiliation(s)
- Anna Cohen
- Royal Free Hospital, Clinical Neurosciences, London, United Kingdom
| |
Collapse
|
32
|
Coskun O, Ucar M, Vuralli D, Yildirim F, Cetinkaya R, Akin Takmaz S, Ucler S. MR Tractography in Short Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) Patients: Case Reports. PAIN MEDICINE 2017; 18:1377-1381. [PMID: 28339630 DOI: 10.1093/pm/pnw334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
| | - Murat Ucar
- Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Funuzar Yildirim
- Department of Algology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Rumeysa Cetinkaya
- Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Suna Akin Takmaz
- Department of Anesthesiology and Reanimation and Algology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Serap Ucler
- Department of Neurology, Istanbul Okmeydani Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
33
|
Benoliel R, Sharav Y, Haviv Y, Almoznino G. Tic, Triggering, and Tearing: From CTN to SUNHA. Headache 2017; 57:997-1009. [DOI: 10.1111/head.13040] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 01/03/2023]
Affiliation(s)
- R. Benoliel
- Rutgers School of Dental Medicine; Rutgers State University of New Jersey; Newark NJ USA
| | - Y. Sharav
- Department of Oral Medicine, The Faculty of Dentistry; Hebrew University-Hadassah; Jerusalem Israel
| | - Y. Haviv
- Department of Oral Medicine, The Faculty of Dentistry; Hebrew University-Hadassah; Jerusalem Israel
| | - G. Almoznino
- Department of Oral Medicine, The Faculty of Dentistry; Hebrew University-Hadassah; Jerusalem Israel
- Department of Oral Medicine; Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces; Tel-Hashomer Israel
| |
Collapse
|
34
|
de Coo I, van Dijk JMC, Metzemaekers JD, Haan J. A Case Report About Cluster-Tic Syndrome Due to Venous Compression of the Trigeminal Nerve. Headache 2016; 57:654-657. [DOI: 10.1111/head.12990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Ilse de Coo
- Department of Neurology; Leiden University Medical Center; Leiden The Netherlands
| | - J. Marc C. van Dijk
- Department of Neurosurgery; University Medical Center Groningen; Groningen The Netherlands
| | | | - Joost Haan
- Department of Neurology; Leiden University Medical Center; Leiden The Netherlands
| |
Collapse
|
35
|
Abstract
Epicrania fugax (EF) is a primary headache of recent description. EF essentially consists of brief paroxysms of pain describing a linear or zigzag trajectory across the surface of one hemicranium, commencing and terminating in the territories of different nerves. The pain of forward EF originates in a particular area of the occipital, parietal or temporal regions and moves anteriorly, whereas the pain of backward EF originates in the frontal area, the eye or the nose and moves posteriorly. Some patients have ocular or nasal autonomic accompaniments, and some have triggers. Between attacks, many patients have continuous or intermittent pain and/or tenderness at the stemming area. Pain frequency is extremely variable and some patients have spontaneous remissions. Preventive therapy is required when the paroxysms are frequent and non-remitting. Neuromodulators, indomethacin, amitryptiline, nerve anesthetic blockades, and trochlear steroid injections have been used in different cases, with partial or complete response.
Collapse
|
36
|
Abstract
Background Short-lasting unilateral neuralgiform headache attacks (SUNA) is a primary headache characterized by frequent attacks of severe headaches in association with ipsilateral cranial autonomic features. SUNA is defined as a strictly unilateral pain and bilateral cases are very unusual, so secondary causes should be searched for vigorously if there are bilateral symptoms. Despite a number of therapeutic trials, effective management for the majority of SUNA patients is not available at present. Management of SUNA is often difficult. Case We report the case of a young boy with bilateral SUNA attacks, with no detected underlying cause, who is responsive to indomethacin. Conclusion Rarely, primary SUNA can present with bilateral symptoms. According to our experience in this case, indomethacin should always be offered to patients with suspected SUNA.
Collapse
Affiliation(s)
- Vlasta Vuković Cvetković
- Danish Headache Center, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Denmark
| |
Collapse
|
37
|
Cação G, Correia FD, Pereira-Monteiro J. SUNCT syndrome: A cohort of 15 Portuguese patients. Cephalalgia 2016; 36:1002-6. [DOI: 10.1177/0333102415620252] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 10/25/2015] [Indexed: 11/17/2022]
Abstract
Background In this paper, we describe a cohort of patients with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), a rare trigeminal autonomic headache, managed in the outpatient clinic of a tertiary hospital. Methods Patients were identified through review of individual records between January 1, 2008 and June 30, 2014. Results Fifteen patients were identified (eight males:seven females), with mean age at onset of 49.7 years, mean number of attacks per day of 7.5 and mean attack duration of 54.6 seconds. Pain was mostly orbital, periorbital or temporal. Cranial autonomic signs/symptoms were universally present; one patient reported ipsilateral epistaxis. Two symptomatic cases were identified and treated surgically. Most patients responded to lamotrigine, one to topiramate and another to eslicarbazepine. Conclusion Our case series is among the largest reported, with findings similar to others already published, but the first to report epistaxis during SUNCT attack and response to eslicarbazepine.
Collapse
Affiliation(s)
- Gonçalo Cação
- Neurology Department, Centro Hospitalar do Porto, Portugal
| | | | - José Pereira-Monteiro
- Neurology Department, Centro Hospitalar do Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
- Instituto de Biologia Molecular Celular (IBMC), Universidade do Porto, Portugal
| |
Collapse
|
38
|
Fernández-Matarrubia M, Gutiérrez-Viedma Á, Cuadrado ML. Case report: Epicranial pain after radiotherapy for skull base meningioma – the first symptomatic epicrania fugax? Cephalalgia 2016; 36:1389-1391. [DOI: 10.1177/0333102416642425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/07/2016] [Accepted: 03/11/2016] [Indexed: 01/03/2023]
Abstract
Background To date, no symptomatic forms of epicrania fugax (EF) have been reported. Here, we describe the first EF-type pain to be probably caused by an underlying disorder. Case report A 77-year-old woman started suffering from left V1–V2 trigeminal neuralgia at 72 years of age. Neurologic examination was normal. Magnetic resonance imaging (MRI) showed a left middle sphenoid wing meningioma compressing the left trigeminal nerve medially. After trying several neuromodulators, she received stereotactic radiotherapy. One month later, the episodes of facial pain were significantly diminished, but she started feeling brief electric paroxysms across her left hemicranium that were clinically identical to those of backwards EF. Serial MRI showed persistence of the meningioma without changes. Conclusion Although the pathogenesis of EF remains uncertain, this case is consistent with a symptomatic origin in the trigeminal root/pathway. The onset of the EF-like pain could have been caused by the compressive effect of the tumour or, most likely, by the radiation.
Collapse
Affiliation(s)
| | | | - María-Luz Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, Universidad Complutense, Madrid, Spain
| |
Collapse
|
39
|
Martins IP, Viana P, Lobo PP. Familial SUNCT in mother and son. Cephalalgia 2016; 36:993-7. [DOI: 10.1177/0333102415616879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/04/2015] [Indexed: 12/14/2022]
Abstract
Background Trigeminal autonomic cephalalgias comprise a heterogeneous group of lateralized headaches associated with ipsilateral autonomic symptoms. They are usually localized within the territory of one or more rami of the trigeminal nerve, but may be localized outside its cutaneous territory. Although these headaches are considered primary disorders, the evidence supporting their genetic nature is lacking, particularly concerning their neuralgic forms, with the exception of a familial case described partly based on a historical account. Case reports We report on a mother and son with episodic, short-lasting, intense, paroxysmal headaches, with the same localization in the left retroauricular region, associated with prominent conjunctival injection and tearing, which are consistent with the diagnosis of SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing). Discussion These cases corroborate the existence of hereditary forms of this disorder, thus supporting its primary nature.
Collapse
Affiliation(s)
- Isabel Pavão Martins
- Lisbon Faculty of Medicine and IMM, University of Lisbon, Portugal
- Headache Outpatient Clinic, Department of Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal
| | - Pedro Viana
- Headache Outpatient Clinic, Department of Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal
| | | |
Collapse
|
40
|
Liapounova NA, VanderPluym JH, Bhargava R, Kolski HH. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing-like attacks in a pediatric patient found to have a pontine capillary telangiectasia and developmental venous anomaly: A case report exploring the root of the problem. Cephalalgia 2016; 37:1093-1097. [PMID: 27342226 DOI: 10.1177/0333102416657148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)-like attacks are rarely reported in the pediatric population and may remain undiagnosed and under-investigated as a result. Case presentation We present a case of a 15-year-old male with intermittent, episodic, right-sided brief headaches most in keeping with SUNCT, initially diagnosed as paroxysmal hemicrania, but with no response to indomethacin. The pain was likewise not responsive to typical migraine treatments or steroids. Management and outcome Contrast-enhanced magnetic resonance imaging demonstrated a right pontine capillary telangiectasia with an associated developmental venous anomaly that was adjacent to the root of the right trigeminal nerve. Differential diagnosis included first division trigeminal neuralgia with autonomic features. The patient's pain was partially alleviated by oxygen administration and responded well to carbamazepine; he remained pain free on carbamazepine a year later. Conclusion This case highlights the diagnostic dilemma of differentiating SUNCT from trigeminal neuralgia with autonomic features, both of which are rare diagnoses in pediatric patients, and the importance of appropriate neuroimaging to rule out secondary causes in patients presenting with trigeminal autonomic cephalalgias, recognizing that abnormalities identified on neuroimaging, such as vessels adjacent to the trigeminal nerve, may not be causative findings.
Collapse
Affiliation(s)
- Natalia A Liapounova
- 1 Department of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada
| | | | - Ravi Bhargava
- 2 Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Hanna H Kolski
- 1 Department of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
41
|
Botulinum Toxin A for the Treatment of a Child with SUNCT Syndrome. Pain Res Manag 2016; 2016:8016065. [PMID: 27445629 PMCID: PMC4904625 DOI: 10.1155/2016/8016065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/09/2015] [Indexed: 01/03/2023]
Abstract
Background. Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome is an unusual cause of headache, mainly described in older adults, and is rare in children. Pain attacks may be severe, frequent, and prolonged. The therapeutic benefits of many drugs are disappointing. Patient and Methods. A 12-year-old boy suffered severe headache and toothache for 20 days. As treatment with nonsteroidal anti-inflammatory drugs, anticonvulsants, and steroids proved ineffective, he was treated with ipsilateral multisite subcutaneous injections of botulinum toxin A 70 U around the orbit, the temporal area, and the upper gum. Results. The pain had reduced in frequency and severity by the fourth day after treatment and had completely disappeared after 7 days. There were no side effects or recurrence during a subsequent 17-month follow-up period. Conclusion. Botulinum toxin A can be used to treat the first episode of SUNCT in children over the age of 12 years.
Collapse
|
42
|
Abstract
Trigeminal autonomic cephalalgias (TACs) are primary headache syndromes that share some clinical features such as a trigeminal distribution of the pain and accompanying ipsilateral autonomic symptoms. By definition, no underlying structural lesion for the phenotype is found. There are, however, many descriptions in the literature of patients with structural lesions causing symptoms that are indistinguishable from those of idiopathic TACs. In this article, we review the recent insights in symptomatic TACs by comparing and categorizing newly published cases. We confirm that symptomatic TACs can have typical phenotypes. It is of crucial importance to identify symptomatic TACs, as the underlying cause will influence treatment and outcome. Our update focuses on when a structural lesion should be sought.
Collapse
Affiliation(s)
- Ilse F de Coo
- Department of Neurology Leiden University Medical Centre, Leiden, The Netherlands,
| | | | | |
Collapse
|
43
|
Abstract
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting neuralgiform headache attacks with cranial autonomic features (SUNA) are rare headache disorders characterized by severe, short-lasting headaches. These headache disorders are often refractory to treatment and can be secondary phenomena. This article reviews the history, pathophysiology, and treatment of these disorders. Both pharmacotherapy and procedural interventions are discussed in context of historical and more recent reports.
Collapse
Affiliation(s)
- Jared L Pomeroy
- Jefferson Headache Center, 900 Walnut St., Suite 200, Philadelphia, PA, 19107, USA,
| | | |
Collapse
|
44
|
Berk T, Silberstein S. Case Report: Secondary SUNCT After Radiation Therapy-A Novel Presentation. Headache 2015; 56:397-401. [DOI: 10.1111/head.12736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/21/2015] [Indexed: 01/03/2023]
Affiliation(s)
- Thomas Berk
- Jefferson Headache Center; Philadelphia PA USA
| | | |
Collapse
|
45
|
Haviv Y, Khan J, Zini A, Almoznino G, Sharav Y, Benoliel R. Trigeminal neuralgia (part I): Revisiting the clinical phenotype. Cephalalgia 2015; 36:730-46. [DOI: 10.1177/0333102415611405] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 06/27/2015] [Indexed: 12/16/2022]
Abstract
Aims We conducted a cross-sectional study to re-examine the clinical profile of patients with a clinical diagnosis of classical trigeminal neuralgia (CTN). Methods Inclusion criteria consisted of the International Headache Society’s published classification of CTN. For the specific purposes of the study, features such as autonomic signs, persistent background pain, attack durations of >2 minutes and reports of pain-related awakening were included. The demographic and clinical phenotype of each patient were carefully recorded for analysis. Results The study cohort consisted of 81 patients and based on reported attack duration these were divided into short (≤ 2 minutes, n = 61) and long (> 2 minutes, n = 20) groups for further analysis. The group with short attack duration neatly fit most of the criteria for CTN while the long attack group presents a more challenging diagnosis. There were no significant differences in pain severity, quality and location between the short and long attack groups. The frequency of persistent background pain was significantly higher in the long (70%) compared to the short attack group (29.5%, p = 0.001). There were significantly more reports of pain-related awakenings in the long (55%) than in the short attack groups (29.5%, p = 0.04). There were no significant differences in the frequency of autonomic signs between the short (21.3%) and long attack groups (40%, p = 0.1). In the short attack group, the presence of autonomic signs was significantly associated with longer disease duration, increased pain-related awakenings, and a reduced prognosis. Conclusion There are clear diagnostic criteria for CTN but often patients present with features, such as long pain attacks, that challenge such accepted criteria. In our cohort the clinical phenotype of trigeminal, neuralgiform pain with or without autonomic signs and background pain was observed across both short and long attack groups and the clinical implications of this are discussed.
Collapse
Affiliation(s)
- Y Haviv
- Department of Oral Medicine, The Faculty of Dentistry, Hebrew University-Hadassah, Israel
| | - J Khan
- Rutgers School of Dental Medicine, Rutgers State University of New Jersey, USA
| | - A Zini
- Department of Community Dentistry, The Faculty of Dentistry, Hebrew University-Hadassah, Israel
| | - G Almoznino
- Department of Oral Medicine, The Faculty of Dentistry, Hebrew University-Hadassah, Israel
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Israel
| | - Y Sharav
- Department of Oral Medicine, The Faculty of Dentistry, Hebrew University-Hadassah, Israel
| | - R Benoliel
- Rutgers School of Dental Medicine, Rutgers State University of New Jersey, USA
| |
Collapse
|
46
|
May A, Goadsby P. The enigma of the interconnection of trigeminal pain and cranial autonomic symptoms. Cephalalgia 2015; 36:727-9. [DOI: 10.1177/0333102415611410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Germany
| | - Peter Goadsby
- NIHR-Wellcome Trust King’s Clinical Research Facility, Kings College London, UK
| |
Collapse
|
47
|
Valença MM, de Oliveira DA. The Frequent Unusual Headache Syndromes: A Proposed Classification Based on Lifetime Prevalence. Headache 2015; 56:141-52. [PMID: 26335933 DOI: 10.1111/head.12646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is no agreement on a single cutoff point or prevalence for regarding a given disease as rare. The concept of what is a rare headache disorder is even less clear and the spectrum from a very frequent, frequent, occasional to rare headache syndrome is yet to be established. OBJECTIVE An attempt has been made to estimate the lifetime prevalence of each of the headache subtypes classified in the ICHD-II. METHOD Using the ICHD-II, 199 different headache subtypes were identified. The following classification was made according to the estimated lifetime prevalence of each headache disorder: very frequent (prevalence >10%); frequent (between 1 and 10%); occasional (between 0.07 and 1%); and unusual or rare (<0.07%). RESULTS One hundred and fifty-four of 199 (77%) were categorized as unusual headache disorders, 7/199 (4%) as very frequent, 9/199 (5%) as frequent, and 29/199 (15%) as occasional forms of headache disorder. CONCLUSION The unusual headache syndromes do not appear to be as infrequent in clinical practice as has been generally believed. About three-fourths of the classified headache disorders found in the ICHD-II can be considered as rare. This narrative review article may be regarded as an introduction to the concept of unusual headaches and a proposed classification of all headaches (at least those listed in the ICHD-II).
Collapse
Affiliation(s)
- Marcelo M Valença
- Department of Neuropsychiatry, Neurology and Neurosurgery Unit, Federal University of Pernambuco, Brazil.,Neurology and Neurosurgery Unit, Hospital Esperança, Brazil
| | - Daniella A de Oliveira
- Department of Neuropsychiatry, Neurology and Neurosurgery Unit, Federal University of Pernambuco, Brazil
| |
Collapse
|
48
|
Kitahara I, Fukuda A, Imamura Y, Ikawa M, Yokochi T. Pathogenesis, Surgical Treatment, and Cure for SUNCT Syndrome. World Neurosurg 2015; 84:1080-3. [PMID: 26008143 DOI: 10.1016/j.wneu.2015.05.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/16/2015] [Accepted: 05/18/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) are characterized by attacks of moderate to severe stabbing pain, strictly unilateral, with periorbital or temporal distribution, associated with cranial autonomic symptoms, such as lacrimation and redness of the ipsilateral eye. METHODS To obtain mechanistic insights into the pathogenesis of SUNCT syndrome, more than 800 cases treated in our institution during the last 7 years were retrospectively reviewed. Two patients showed typical autonomic symptoms of SUNCT. RESULTS Magnetic resonance imaging suggested potential compression of the trigeminal nerve by the intracranial artery in these cases and complete remission was achieved by microvascular decompression. CONCLUSIONS Microvascular decompression provides an appropriate therapeutic choice if vascular compression of the trigeminal nerve is identified. From our 2 cases, we propose that, in some cases of SUNCT diagnosed previously, characteristic symptoms were induced by compression of the side surface of the first branch of the trigeminal nerve at the root exit zone by the intracranial artery.
Collapse
Affiliation(s)
- Isao Kitahara
- Department of Neurosurgery, Chiba Tokushukai Hospital, Funabashi, Japan.
| | - Ataru Fukuda
- Department of Neurosurgery, Chiba Tokushukai Hospital, Funabashi, Japan
| | - Yoshiki Imamura
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry, Tokyo, Japan
| | - Masako Ikawa
- Department of Oral Surgery, Shizuoka-Shimizu Municipal Hospital, Shimizu, Japan
| | - Tomoki Yokochi
- Department of Clinical Research, Chiba Tokushukai Hospital, Funabashi, Japan
| |
Collapse
|
49
|
Paliwal VK, Uniyal R, Gupta DK, Neyaz Z. Trigeminal neuralgia or SUNA/SUNCT: a dilemma unresolved. Neurol Sci 2015; 36:1533-5. [PMID: 25905432 DOI: 10.1007/s10072-015-2215-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 04/13/2015] [Indexed: 01/03/2023]
Affiliation(s)
- Vimal Kumar Paliwal
- Department of Neurology and Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, Uttar Pradesh, India,
| | | | | | | |
Collapse
|
50
|
[Therapy of trigeminal autonomic headaches]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 57:983-95. [PMID: 25005009 DOI: 10.1007/s00103-014-2003-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Trigeminal autonomic cephalgias (TAC) are characterized by severe and strictly unilateral headaches with a frontotemporal and periorbital preponderance in combination with ipsilateral cranial autonomic symptoms, such as lacrimation, conjunctival injection, rhinorrhea, nasal congestion, and restlessness or agitation. One main differentiating factor is the duration of painful attacks. While attacks typically last 5 s to 10 min in SUNCT syndrome (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing), paroxysmal hemicrania lasts 2-30 min and cluster headaches 15-180 min. Hemicrania continua represents a continuous TAC variant. From a therapeutic view, TACs differ substantially. Lamotrigine is used as first-choice prevention in SUNCT syndrome and indometacin in paroxysmal hemicrania. For cluster headaches, acute therapy with inhaled pure oxygen and fast-acting triptans (sumatriptan s.c. and intranasal zolmitriptan) is equally important to short-term preventive therapy with methysergide and cortisone and long-term prophylactic treatment comprising verapamil as drug of first choice and lithium carbonate and topiramate as drugs of second choice. In refractory cases of chronic cluster headache, neuromodulatory approaches such as occipital nerve stimulation and sphenopalatine ganglion stimulation are increasingly applied.
Collapse
|