SUNCT syndrome responding absolutely to steroids i

Authors: María de Lourdes Figuerola Osvaldo Bruera María Josefina Pozzo Jorge Leston

Publish Date: 2009/02

Volume: 10, Issue: 1, Pages: 55-

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Abstract

SUNCT is a syndrome of shortlasting unilateral neuralgiform headache attacks with conjunctival injection and tearing We are presenting now two cases absolutely responders to steroid therapy one of them a SUNCTlike secondary to a prolactinoma and the other primarySuggested criteria for its diagnosis include attacks of unilateral moderately severe orbital or temporal stabbing or throbbing pain lasting 5–240 s with an attack frequency of 3–200 per day and pain is associated with important ipsilateral autonomic manifestations 3 It is among the rarest headache syndromesSeveral patients with secondary SUNCT syndromes have been reported since 1991 They were associated with cerebellopontine angle MAV parapontine cavernous angioma dorsolateral brainstem infarction HIV infection basilar impression craniosynostosis and hypophyseal tumors 4Treatments—including methysergide lithium propanolol amitriptyline carbamazepine and prednisone—usually have poor or negative results Recently some partial improvements have been described with the use of lamotrigine gabapentin and topiramate 5–8A 50yearold male patient had his first pain attack 4 years before admission He described a daily severe pulsating pain over the left supraorbital ridge and orbit extended to the left temple associated with prominence of autonomic symptoms such as lacrimation and conjunctival injection Each individual attack lasted 15–120 s and occurred three to six times per day Neck and head movements triggered pain attacks He was prescribed amitriptyline indomethacin topiramate and carbamazepine which did not ameliorate his pain

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