SUNCT syndrome associated with compression of trigeminal nerve

Cephalalgia, 1992

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) were first described by Sjaastad et al. (1). It has been accepted as unilateral orbital, supraorbital or temporal or pulsating pain lasting 5-240 s. Pain is accompanied by ipsilateral conjunctival injection and lacrimation. Attacks occur with a frequency from 3 to 200 per day (2).

Brain, 2006

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic features (SUNA) are described, although SUNA is rarely reported. The phenotype of SUNCT and SUNA was characterized from a large series of patients (43 SUNCT, 9 SUNA). Three attack types were identified: stabs, groups of stabs and saw-tooth attacks. The mean duration of stabs was 58 s (1-600 s); stab groups, 396 s (10-1200 s); and saw-tooth, 1160 s (5-12 000s). The attack frequency was a mean of 59 attacks/day (2-600), and this depended largely on the type of attack. The pain was orbital, supraorbital or temporal in 38 (88%) SUNCT and 7 (78%) SUNA, and also occurred in the retro-orbital region, side, top, back of head, second and third trigeminal divisions, teeth, neck and ear. All SUNCT patients had conjunctival injection and tearing. Two SUNA patients had conjunctival injection, four had tearing, but none had both. Other cranial autonomic symptoms included nasal blockage, rhinorrhoea, eyelid oedema, facial sweating/flushing and ear flushing. Cutaneous stimuli triggered attacks in 74% of SUNCT but only in 22% of SUNA patients. The majority (95% SUNCT and 89% SUNA) had no refractory period between attacks. For SUNCT 58% and for SUNA 56% of patients were agitated with the attacks. We propose a new set of diagnostic criteria for these syndromes to better encompass the clinical presentations and which include a wider range of attack length, wider trigeminal pain distribution, cutaneous triggering and lack of refractory period.

2020

A 28-year old male with a history of SUNCT headache for 6 months presented with left forehead stabs lasting for 30 seconds with a frequency of 40-45 episodes per hour for three days followed by infective gastroenteritis. His neurological examination was normal, except left-sided ptosis, tearing, and conjunctival injection. His MRI brain with contrast, MR angiography, and laboratory investigations were unremarkable except mild hypokalemia. He was treated with intravenous fluids, potassium replacement, and high dose methylprednisolone along with an escalated dose of carbamazepine.

World Neurosurgery

The Journal of Headache and Pain, 2012

Background Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform attacks with cranial autonomic features (SUNA) are rare primary headache syndromes characterized by spontaneous or triggered attacks of unilateral, brief, multiple, orbitofrontal pain associated with ipsilateral autonomic features. SUNCT is considered as a subset of SUNA. In SUNA, there may be cranial autonomic symptoms other than conjunctival injection and lacrimation, or either of two is present. SUNCT/SUNA can be triggered immediately after or at the decrescendo phase of the ongoing attack without any intervening refractory period. Refractory period is usually present in trigeminal neuralgia. Absent refractory period is thought to reliably differentiate SUNCT/SUNA from trigeminal neuralgia and has been proposed for inclusion into the International Classification of Headache Disorders (ICHD) diagnostic criteria for SUNCT. Case reports We report three patients of SUNCT syndrome with preserved intervening refractory period of variable duration observed at different times. Discussion Trigeminal neuralgias with autonomic features, SUNA and SUNCT share a common pathophysiological mechanism and actually represent a continuum. It is well known that patient with trigeminal neuralgia may transform into SUNCT/SUNA. Similarly, being a continuum, the presence or the absence of refractory period and its duration may change in a patient with SUNCT/SUNA at different time points. Conclusion The presence of refractory period should not exclude the diagnosis of SUNCT in a patient with other clinical features suggestive of SUNCT. Keywords Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) Á Refractory period Á Trigeminal neuralgia with autonomic features Á Short-lasting unilateral neuralgiform attacks with cranial autonomic features (SUNA)

Headache Medicine

Background: Trigeminal autonomic cephalalgias comprehend a myriad of headaches with different symptoms, with comprehend short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) or with conjunctival injection and tearing (SUNCT). Current treatment options are limited, and they are based mostly on case reports and small studies. Case Report: We report here the case of a 75 years old man suffering from acutetrigeminal autonomic headache with a satisfying response to intranasal lidocaine and nerve blockage. Conclusion: Intranasal lidocaine and nerve blockage may represent a useful and costeffective treatment for patients with SUNCT/SUNA.

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2015

Arquivos de Neuro-Psiquiatria, 2007

sUNct is one of the rarest and least known primary headache disorders. Although its pathogenesis has been partially understood by functional neuroimaging and reports of secondary cases, there is limited understanding of its cause. We report a case of sUNct in a 54-years-old man, that could not be strictly classified as secondary sUNct; however, the time lag of pain onset suggests a new theory in which neuroplasticity could be involved in the origin and duration of the pain in sUNct syndrome.

Cephalalgia, 2009

Trigeminal neuralgia (TN) is a common unilateral disorder characterized by brief electric shock-like pains, abrupt in onset and termination, limited to the distribution of one or more divisions of the trigeminal nerve. Indeed, pain is commonly evoked by trivial stimuli, including washing, shaving, smoking, talking, or brushing the teeth and frequently occurs spontaneously (1). Cluster headache (CH), short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms, and paroxysmal hemicrania (PH) are classified as trigeminal-autonomic cephalalgias (TACs). These cephalalgias, according to International Classification of Headache Disorders, 2nd edn (ICHD-II) criteria, share the clinical features of headache accompanied by cranial parasympathetic autonomic features (1). These syndromes seem to be different and well-characterized. However, in recent years some cases have been described in which syndromes co-existed or switched from one type to another in the same patient. This event raised doubt that there could be some common mechanisms among them. We describe a patient who resurrects this problem. She first presented with TN, later developed SUNCT, and then manifested TN attacks, followed by CH, and finally SUNCT without TN attacks.

Cephalalgia, 2001