Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome: a review

Abstract

The clinical features of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome have been reviewed in 50 patients reported in the English language literature. SUNCT syndrome is a rare condition that predominates slightly in men. The mean age at onset is 50 years. It is characterized by strictly unilateral attacks centered on the orbital or periorbital regions, forehead, and temple. Generally, the pain is severe and neuralgic in character. The usual duration ranges from 5 to 250 seconds, although the reported range of duration is 2 seconds to 20 minutes. Ipsilateral conjunctival injection and lacrimation are present in most, but not all patients. Most patients are thought to have no refractory periods and this has probably been unreported in the past. Episodic and chronic forms of SUNCT exist. The attack frequency varies from less than one attack daily to more than 60 attacks per hour. The attacks are predominantly diurnal, although frequent nocturnal attacks can occur in some patients. A functional magnetic resonance imaging study in SUNCT syndrome has demonstrated ipsilateral hypothalamic activation. SUNCT was thought to be highly refractory to treatment. However, recent open-label trials of lamotrigine, gabapentin, topiramate, and intravenous lidocaine have produced beneficial therapeutic responses. These results offer the promise of better treatments for this syndrome, but require validation in controlled trials.

SUNCT and SUNA: medical and surgical treatments

“…Six of the 11 patients taking prednisone reported a beneficial response. Six of the eight patients taking prednisolone or methylprednisolone reported a favourable effect [15,21,22]. In particular, oral administration of methylprednisolone for 3-6 weeks at the daily doses of B1 mg/kg was efficacious in suppressing bouts of SUNCT attacks in three patients with the episodic form of the disorder [23].…”

“…In 22 of 33 patients (67 %), there was no beneficial response with the sole use of carbamazepine. Among the 11 patients with a favourable response, 8 of the 33 patients had a partial response and 3 had a complete or almost complete response [15]. In a recent open-label series of 36 SUNCT and 5 SUNA patients treated with carbamazepine, 40 % of SUNCT and 20 % of SUNA patients reported a favourable response [6].…”

Mecanismos envolvidos na analgesia da lidocaína por via venosa

“…Em casos de cefaléias refratárias ao tratamento convencional por via oral, a lidocaína em baixas doses por via venosa foi eficaz 37 . Mesmo a administração por via peritoneal (12,5 mg.h -1 ) resultou em menor consumo de opióides no pós-operatório em pacientes submetidas a histerectomia abdominal 38 , e foi usada em bolus antes da anestesia na prevenção da dor isquê-mica do garrote durante a anestesia intravenosa regional 39 .…”

“…The toxic dose seems to change in patients with terminal diseases 36 . The intravenous administration of low doses of lidocaine was effective in the management of headaches refractory to conventional oral treatment 37 . Even the intraperitoneal administration of lidocaine (12.5 mg.h -1 ) reduced postoperative opioid consumption in patients undergoing abdominal hysterectomy 38 , and it was also used, as a bolus, before anesthesia to prevent the ischemic tourniquet pain during intravenous regional anesthesia 39 .…”

Sunct-Like Syndrome In A Patient With Small Cell Lung Cancer

“…Diagnostic criteria for SUNCT syndrome was defined in the second edition of the International Classification of Headache Disorders (ICHD-II) (7). SUNCT syndrome is a rare condition that predominates slightly in men (8). In the vast majority of patients, etiology and pathogenesis are unknown.…”