Which drug has shown benefit in treating SUNCT?

By | May 13, 2012

Which medication has shown benefit in treating SUNCT and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA)?

A. Lamotrigine (Lamictal)

B. Gabapentin (Neurontin)

C. Topiramate (Topamax)

D. Lidocaine

E. All of the above

The answer is E. SUNCT and SUNA are primary headache syndromes, classified as TACs, and associated with hypothalamic activation. They respond to IV lidocaine, but not indomethacin (Indocin). Preventive treatments include lamotrigine (Lamictal), gabapentin (Neurontin), and topiramate (Topamax). (Cohen, Cephalalgia 2007)

Which of the following is associated with headache after childbirth?

A. Cervicocephalic artery dissection

B. Reversible posterior leukoencephalopathy syndrome

C. Eclampsia

D. Reversible cerebral vasoconstriction syndrome

E. All of the above

The answer is E. A study of cervicocephalic artery dissection (CAD) found that women with postpartum CAD often had coexisting conditions such as reversible cerebral vasoconstriction syndrome, reversible posterior leukoencephalopathy syndrome, and subarachnoid hemorrhage without signs of intracranial extension of CAD. The authors concluded that CAD and associated conditions should be considered in women with unusual headaches after childbirth. Eclampsia and pre-eclampsia, which can occur up to 6 weeks after delivery, may present with postpartum headaches as well. (Arnold, Camus-Jacqmin, Stapf, et al., Stroke 2008)

Autonomic symptoms (lacrimation, nasal congestion, ptosis, miosis) are absent in which of the following primary headaches?

A. Hemicrania continua

B. Chronic paroxysmal hemicrania

C. Cluster headache (CH)

D. Short-lasting, unilateral, neuralgiform headache attacks with conjuncti-val injection and tearing (SUNCT) syndrome

E. None of the above

The answer is E. All of the listed headache types are characterized by both sympathetic and parasympathetic symptoms. The TACs are a group of primary headache disorders, mediated by the hypothalamus, with unilateral head pain in association with ipsilateral cranial autonomic cranial autonomic features. The TACs include paroxysmal hemicrania, CH, and SUNCT/SUNA syndrome. Hemicrania continua is not classified as a TAC, although it shares autonomic symptoms with all the TACs and indomethacin responsiveness with paroxysmal hemircrania. (Goadsby, Cohen, &Matharu, Curr Neurol Neurosci Rep 2007)

SUNCT is best distinguished from trigeminal neuralgia by which attack characteristic?

A. Refractory period

B. Location of pain

C. Duration of pain

D. Frequency of attacks of pain

E. Gender of patient

The answer is A. The majority of patients with SUCNT do not have the refractory period after an attack of pain that is characteristic of trigeminal neuralgia. Although the pain of SUNCT is most usually periorbital, and the pain of trigeminal neuralgia is usually in the lower face, there can be overlap in the site of attacks of both pain syndromes. The duration of stabbing pain with SUNCT can be seconds, with a mean attack frequency of ranging from a few to hundreds a day, similar to trigeminal neuralgia. Both conditions occur in both genders, although SUNCT is more common in men. SUNCT, a TAC, is associated with autonomic symptoms, which are not seen with trigeminal neuralgia. (Cohen, Cephalalgia 2007)