Sunct Syndrome: Priming of Symptomatic Periods and Worsening of Symptoms by Treatment with Calcium Channel Blockers

Jiménez‐Huete, Adolfo; Franch, Oriol; Pareja, JA

doi:10.1046/j.1468-2982.2002.00446.x

Cited by 13 publications

(10 citation statements)

References 24 publications

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“…In one patient, it was only administered in combination with other medications [16]. When verapamil was administered solely, it was ineffective in all of the patients; in fact, five patients reported a worsening of the attacks with verapamil [3,21,49]. Of the three patients in whom it was used in combination with other agents, a beneficial response was reported in two of them; in one patient, verapamil was highly effective when used in combination with carbamazepine [16], but it was partially effective when used in combination with carbamazepine, naloxone, and lithium in the other patient [9].…”

Section: Calcium Channel Antagonistsmentioning

confidence: 99%

“…Symptomatic periods generally last from a few days to several months and occur once or twice annually, although a maximum of 22 episodes per year have been reported [5]. Remissions typically last for a few months, but can last from 1 week to 8.5 years [21]. Symptomatic periods appear to increase in frequency and duration over time [5].…”

Section: Frequency and Periodicity Of Attacksmentioning

confidence: 99%

“…Of the three patients in whom it was used in combination with other agents, a beneficial response was reported in two of them; in one patient, verapamil was highly effective when used in combination with carbamazepine [16], but it was partially effective when used in combination with carbamazepine, naloxone, and lithium in the other patient [9]. A trial of verapamil as a pharmacologic precipitant of attacks has been advocated in the treatment of SUNCT syndrome [21]. This approach is likely to be fraught with difficulties because verapamil induces a worsening in only approximately one third of the patients, there is a marked spontaneous variability in the attack frequency of SUNCT syndrome, the placebo and nocebo response rates are unknown, and there is an ethical concern regarding administering a drug that worsens a pain syndrome in the absence of a rapidly effective abortive or preventive agent.…”

Section: Calcium Channel Antagonistsmentioning

confidence: 99%

“…Amlodipine has been reported to worsen the attacks for the sole patient to whom it was administered [21]. Flunarizine and diltiazem have been administered to two and one patients, respectively, without any benefit.…”

Section: Calcium Channel Antagonistsmentioning

confidence: 99%

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

Matharu¹,

Cohen²,

Boes³

et al. 2003

Current Science Inc

110

114

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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.

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Section: Calcium Channel Antagonistsmentioning

confidence: 99%

Section: Frequency and Periodicity Of Attacksmentioning

confidence: 99%

Section: Calcium Channel Antagonistsmentioning

confidence: 99%

Section: Calcium Channel Antagonistsmentioning

confidence: 99%

See 2 more Smart Citations

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

Matharu¹,

Cohen²,

Boes³

et al. 2003

Current Science Inc

110

114

View full text Add to dashboard Cite

show abstract

“…Literatürde, carbamazepine (84), oxcarbazepine (85), zonisamide (86) gibi farkl› ilaçlar ile olumlu sonuçlar al›nd›¤› bildirilmekle beraber; birbiri ile z›t düflen vaka çal›flmalar› da mevcuttur (87,88). EFNS trigeminal otonomik sefaljiler tedavi rehberi (2006) ve baz› önemli gözden geçirme yaz›lar›nda (89,90,91) lamotrigine, topiramate ve gabapentin öne ç›kmaktad›r.…”

Section: Sunct Tedavisiunclassified

Trigeminal Otonomik Sefaljilerde Tedavi

Selekler¹,

Altun²

2011

npa

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Trigeminal autonomic cephalgias -cluster headache, paroxysmal hemicrania (PH), hemicrania continua (HC) and SUNCT (short-lasting unilateral headache attacks with conjunctival injection and tearing)-are characterized by ipsilateral autonumic features accompanying the unilateral headache. A well-established medical treatment exists for cluster headache. However, problems could arise when treating chronic forms. Main treatment option for PH and HC is indomethacin. Troubles may occur when indomethacin is contrindicated and when replacing it with another agent is needed. Although lamorigine is the most well-known drug in SUNCT treatment, it is not a key drug such as indomethacin. Surgical procedures (e.g. occipital nerve stimulation and hypothalamic stimulation), which have been developed in the last ten years, are promising in the treatment of drug-resistant trigeminal autonomic cephalgia patients. (Archives of Neuropsychiatry 2010; 47: 279-85)

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SUNCT and SUNA: Recognition and Treatment

Pareja

Álvarez

Montojo

2012

Curr Treat Options Neurol

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The problem of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) management remains unsolved. Despite a myriad of therapeutic trials, no convincingly effective remedy for SUNCT and SUNA is available at present. Based on open-label communications, some patients seemed to benefit from some pharmacologic, interventional, or invasive procedures. Possible effective preventive drugs are carbamazepine, lamotrigine, gabapentin, and topiramate. At present, the drug of choice for SUNCT seems to be lamotrigine whereas SUNA may better respond to gabapentin. There is no available abortive treatment for the individual attacks. During the worst periods, intravenous lidocaine may decrease the flow of SUNCT/SUNA attacks. In SUNCT, bilateral blockade of the greater occipital nerve, and superior cervical ganglion opioid blockade have been reported as temporary/partially effective in one patient each. Botulinum toxin injected around the symptomatic orbit provided sustained relief to one patient. Owing to the scarcity of reports the results of these interventions should be taken as preliminary. Invasive therapy with interventions directed to the first division of the trigeminal nerve or Gasserian ganglion, with local anesthetics or alcohol, radiofrequency thermocoagulation, microvascular decompression, and gamma-knife neurosurgery, have been tried in the treatment of refractory SUNCT. Some patients seemed to benefit from such interventions, but one should still have a critical attitude to these claims since no convincing results have been obtained as yet. The few SUNCT patients who underwent deep brain hypothalamic stimulation obtained a substantial and persistent relief.

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Sunct Syndrome: Priming of Symptomatic Periods and Worsening of Symptoms by Treatment with Calcium Channel Blockers

Cited by 13 publications

References 24 publications

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

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

Trigeminal Otonomik Sefaljilerde Tedavi

SUNCT and SUNA: Recognition and Treatment

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