SUNCT, SUNA and short-lasting unilateral neuralgiform headache attacks: Debates and an update

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.

Association between glaucoma eye drops and hyperemia

PURPOSE

We used an image analysis software program to quantitatively investigate conjunctival injection in patients treated with eye drops for glaucoma.

METHODS

We compared 169 patients (89 men and 80 women) with a diagnosis of glaucoma. Photographs of the conjunctiva were taken on the temporal side of each patient's right eye using a slit lamp. We determined the mean pixel frequencies of the conjunctival blood vessels from the photographs.

RESULTS

The ocular hyperemia of the patients being treated with prostaglandins was more severe than that of the patients being treated with beta-blockers or no eye drops. In multiple comparisons of each of the eye drops, the control group had a significantly lower degree of hyperemia than did the patients being treated with each of the various prostaglandin analogs (latanoprost, travoprost, tafluprost, and bimatoprost). Among the patients receiving prostaglandin, the percentage of those with hyperemia was highest in the bimatoprost users, followed in order by the travoprost, latanoprost, and tafluprost users. However, no significant differences were found among the different prostaglandin analogs in terms of the percentage of patients with hyperemia.

CONCLUSION

Our software program may be useful for evaluating the hyperemic effects of eye drops used for glaucoma. The particular type of prostaglandin analog seems to determine the level of conjunctival hyperemia during ocular hypotensive medical treatment.

Acetazolamide and Thyroid-Associated Ophthalmopathy; a Preliminary Tested Hypothesis in a TertiaryReferral Center

This study evaluated the effect of acetazolamide on thyroid-associated ophthalmopathy (TAO). Patients with a VISA classification index equal to or more than four were enrolled in the study and were randomly assigned into two groups. In both groups, treatment was initiated using prednisolone. Patients in the case group received acetazolamide tablets 250 mg daily in addition to prednisolone. Three months later, the VISA inflammatory score of patients in both groups were determined. Subsequent to intervention with acetazolamide, the VISA inflammatory score of patients in the case group were reduced as follows; orbital pain (57.1% versus 41.7%, P=0.736), eyelid edema (42.8% versus 27.1%, P=0.67), chemosis (53.3% versus 33%, P=0.31), injection of the eyelids (60% versus 41.6%, P=0.342), and conjunctival injection (50% versus 46.13%, P=0.73). However, these reductions were not statistically significant when compared with those observed in the control group (P=0.246). In conclusion, the effect of acetazolamide on all the parameters of the VISA inflammatory score was examined independently. All patients in the case group revealed a reduction in VISA inflammatory score following intervention. However, these reductions were not statistically significant. Further studies with large sample sizes are required.