Functional magnetic resonance imaging in spontaneous attacks of SUNCT: Short-lasting neuralgiform headache with conjunctival injection and tearing

May, Arne; Bahra, Anish; Büchel, Christian; Turner, Robert; Goadsby, Peter J.

doi:10.1002/1531-8249(199911)46:5<791::aid-ana18>3.0.co;2-8

Cited by 302 publications

(241 citation statements)

References 16 publications

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“…In view of the functional imaging evidence of activation of the posterior hypothalamus region being linked to attacks of SUNCT [5] and the broad experience in the use of posterior hypothalamic region deep brain stimulation (DBS) in patient with medically intractable cluster headache (CH), three patients with intractable SUNCT have been treated with DBS in the region of the posterior hypothalamus. The outcome of the three patients was promising, with a significant and sustained decrease in attack frequency, respectively, at 18-month [37], 12-month [38] and 15-month follow-up [39].…”

Section: Deep Brain Stimulation Of the Posterior Hypothalamic Regionmentioning

confidence: 99%

“…The activation of the posterior hypothalamus during attacks, demonstrated in functional neuroimaging studies [5,6], has led to the hypothesis that the posterior hypothalamus plays a crucial role in the pathophysiology of SUNCT syndrome. However, besides the occurrence of ipsilateral autonomic symptoms during attacks, there are few other similarities shared between SUNCT/SUNA and the other TACs syndromes.…”

Section: Introductionmentioning

confidence: 99%

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SUNCT and SUNA: medical and surgical treatments

Lambru

Matharu

2013

Neurol Sci

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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 and often disabling primary headache disorders. Their management can be challenging. The abortive therapies are not generally useful as the attacks are relatively short lasting. A myriad of pharmacological preventive treatments have been tried in single case reports or small series in an openlabel fashion. Lamotrigine, as an oral preventive treatment, and lidocaine, as an intravenous transitional treatment, seem to be the most effective therapies. For medically intractable chronic forms of SUNCT and SUNA, several surgical approaches have been tried. These include ablative procedures involving the trigeminal nerve or the Gasserian ganglion, microvascular decompression of the trigeminal nerve, and neurostimulation techniques. This review provides an overview of the current pharmacological and surgical options for SUNCT and SUNA syndromes.

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Section: Deep Brain Stimulation Of the Posterior Hypothalamic Regionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

SUNCT and SUNA: medical and surgical treatments

Lambru

Matharu

2013

Neurol Sci

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“…No SUNCT foi descrita uma ativação da área postero-inferior do hipotálamo ipsilateral a dor 19 , mesma alteração encontrada na cefaléia em salvas 20 , bem como uma ativação hipotalâmica bilateral 21 . Esses achados falam a favor de uma origem central para esta cefaléia.…”

Section: Discussionunclassified

Uso de gabapentina no tratamento da Síndrome SUNCT

Rocha-Filho

Rabello

Galvão

et al. 2007

Arq. Neuro-Psiquiatr.

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A síndrome SUNCT (short-lasting unilateral neuralgiform headache attacks with conjuntival injection and tearing) foi descrita pela primeira vez por Sjaastad e colaboradores em 1989 1 , só recentemente sendo incluída na segunda edição da Classificação Internacional de Cefaléias no grupo que inclui a cefaléia em salvas e outras cefaléias trigêmino-autonômicas 2 . Esta cefaléia é caracterizada por dor unilateral, orbitária, supra-orbitária ou temporal, em pontada ou pulsátil, com duração de 5-240 segundos, associada a hiperemia conjuntival e lacrimejamento ipsilaterais a mesma 2 . Os sintomas autonômicos, em geral dramáticos, iniciam-se rapidamente após o início da dor, podendo haver além dos já citados, rinorréia e obstrução nasal 1,3,4 . As crises podem ter freqüência variável, de uma a duas crises por dia a até 10-30 crises por hora, de ocorrência geralmente diurna 5 , podendo ser precipitada por manobras mecânicas do pescoço e por zonas gatilho em topografias trigeminais e extra-trigeminais, geralmente não se observando períodos refratários após estímulos sucessivos 1,4,6 . Esta síndrome inicia-se geralmente entre os 41 e 70 anos (média de 51 anos) 4 e tem uma predominân-cia do sexo masculino 4,5 . As crises têm padrão irregular, com alternância errática entre períodos com dor, que variam de dias a meses e geralmente ocorrem 1 a 2 vezes por ano, e períodos de remissão que podem durar meses 4 . Dentre as cefaléias primárias, temos como diagnósticos diferenciais a hemicrânia paroxística crônica, a cefaléia em salvas, a neuralgia do primeiro ramo do trigêmio e a cefaléia idiopática em facadas 7 . Apesar RESUmO -Relatamos o caso clínico de duas mulheres com quadro compatível com síndrome SUNCT (cefaléia de curta duração, unilateral, neuralgiforme com hiperemia conjuntival e lacrimejamento). As duas apresentavam exames clínico e neurológico normais e Rm com sinais de microangiopatia. A primeira apresentava cefaléia há três anos, que ocorria várias vezes por dia, sempre que mastigava ou bocejava. Havia feito uso várias medicações sem melhora. A dor foi controlada após o uso de 600 mg de gabapentina ao dia. A segunda paciente referia cefaléia há seis meses. A dor era diária, ocorrendo de 20-40 vezes por dia. Na ocasião da primeira avaliação no ambulatório, já fazia uso 600 mg de carbamazepina ao dia e 15 mg de clorpromazina, com melhora parcial. Após introdução de gabapentina-1200 mg/ dia, a paciente evoluiu sem dor, porém com episódios de hiperemia conjuntival.PAlAvRAS-CHAvE: SUNCT, cefaléia, tratamento, gabapentina, dor, cefaléia ultra-curta.gabapentin in the treatment of sUnCt syndromeAbSTRACT -We report the cases of two women who presented a clinical condition compatible with the SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) syndrome. both presented normal clinical and neurological examination and mRI compatible with microangiopathy. The first one related headache attacks for three years, occurring several times a day when she masticated or yawned. She had a...

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“…11 This latter area was initially thought to be activated only in cluster headache, and was proposed as the cluster generator. 11 It was subsequently shown, however, that this hypothalamic area is also activated during SUNCT, 12 PH, 13 and hemicrania continua. 14 Hemicrania continua is a strictly unilateral headache accompanied by ipsilateral oculofacial autonomic symptoms not now considered to be a trigeminal autonomic cephalalgia, because of its long-lasting pain.…”

Section: Rationale For Hypothalamic Stimulation In Headachementioning

confidence: 99%

“…63 After a functional MRI study had shown increased blood flow in the ipsilateral posterior inferior hypothalamus during SUNCT attacks, 12 the posterior inferior hypothalamus of a patient experiencing severe intractable SUNCT was implanted. 64 Prolonged stimulation resulted in long-lasting pain relief without continuous drug administration and with virtually no adverse effects.…”

Section: Sunct Syndrome and Paroxysmal Hemicraniamentioning

confidence: 99%

Deep Brain Stimulation in Trigeminal Autonomic Cephalalgias

et al. 2010

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Summary:Cluster headache (CH), paroxysmal hemicrania (PH), and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome) are primary headaches grouped together as trigeminal autonomic cephalalgias (TACs). All are characterized by short-lived unilateral head pain attacks associated with oculofacial autonomic phenomena. Neuroimaging studies have demonstrated that the posterior hypothalamus is activated during attacks, implicating hypothalamic hyperactivity in TAC pathophysiology and suggesting stimulation of the ipsilateral posterior hypothalamus as a means of preventing intractable CH. After almost 10 years of experience, hypothalamic stimulation has proved successful in preventing pain attacks in approximately 60% of the 58 documented chronic drug-resistant CH patients implanted at various centers. Positive results have also been reported in drug-resistant SUNCT and PH. Microrecording studies on hypothalamic neurons are increasingly being performed and promise to make it possible to more precisely identify the target site. The implantation procedure has generally proved safe, although it carries a small risk of brain hemorrhage. Long-term stimulation is proving to be safe: studies on patients under continuous hypothalamic stimulation have identified nonsymptomatic impairment of orthostatic adaptation as the only noteworthy change. Studies on pain threshold in chronically stimulated patients show increased threshold for cold pain in the distribution of the first trigeminal branch ipsilateral to stimulation. When the stimulator is switched off, changes in sensory and pain thresholds do not occur immediately, indicating that long-term hypothalamic stimulation is necessary to produce sensory and nociceptive changes, as also indicated by clinical experience that CH attacks are brought under control only after weeks of stimulation. Infection, transient loss of consciousness, and micturition syncope have been reported, but treatment interruption usually is not required.

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Functional magnetic resonance imaging in spontaneous attacks of SUNCT: Short-lasting neuralgiform headache with conjunctival injection and tearing

Cited by 302 publications

References 16 publications

SUNCT and SUNA: medical and surgical treatments

SUNCT and SUNA: medical and surgical treatments

Uso de gabapentina no tratamento da Síndrome SUNCT

Deep Brain Stimulation in Trigeminal Autonomic Cephalalgias

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