scholarly journals Differential diagnosis short-lasting unilateral neuralgiform headache attacks and trigeminal neuralgia

2019 ◽  
Vol 10 (2) ◽  
pp. 60-65
Author(s):  
E. V. Parkhomenko ◽  
S. E. Nartov
Keyword(s):  
Differential Diagnosis ◽  
Trigeminal Neuralgia ◽  
Diagnostic Criteria ◽  
Conjunctival Injection ◽  
Short Term ◽  
Autonomic Symptoms ◽  
Cranial Autonomic Symptoms

The article presents diagnostic criteria, comparative characteristics of short-lasting unilateral neuralgiform headache attacks, including short-term unilateral neuralgic headaches with conjunctival injection and lacrimation (SUNCT) and short-term unilateral neuralgic headaches with cranial autonomic symptoms (SUNA), differential diagnosis with trigeminal neuralgia.

Unilateral Cranial Autonomic Symptoms in Migraine

Cephalalgia ◽  
2002 ◽  
Vol 22 (4) ◽  
pp. 256-259 ◽  
Author(s):  
P Barbanti ◽  
G Fabbrini ◽  
M Pesare ◽  
N Vanacore ◽  
R Cerbo
Keyword(s):  
Large Scale ◽  
Nasal Congestion ◽  
Migraine Treatment ◽  
Conjunctival Injection ◽  
Autonomic Symptoms ◽  
Therapeutic Implications ◽  
Ocular Symptoms ◽  
Cranial Autonomic Symptoms ◽  
Nasal Symptoms ◽  
Autonomic Reflex

Unilateral cranial autonomic symptoms (UAs) such as lacrimation, conjunctival injection, eyelid oedema and nasal congestion, which are the hallmark of trigeminal autonomic cephalgias, may also occur in an as yet undetermined proportion of migraine patients. We studied 177 consecutive migraineurs to assess the frequency of UAs and the clinical characteristics of such patients. UAs were reported by 81 patients (45.8%), ocular symptoms alone or in combination with nasal symptoms being the most frequent. The headache was more severe ( P< 0.0002) and more strictly unilateral ( P< 0.0004) in patients who reported UAs than in those without. Thus, the presence of UAs suggests an activation of the trigeminal-autonomic reflex, probably related to an over-activation of the trigeminal afferent arm. These findings could have therapeutic implications, given the potential large-scale recruitment of peripheral neurovascular 5-HT1B/1D receptors (the target of acute migraine treatment) in such patients.

scholarly journals Phenotypic and treatment outcome data on SUNCT and SUNA, including a randomised placebo-controlled trial

Cephalalgia ◽  
2017 ◽  
Vol 38 (9) ◽  
pp. 1554-1563 ◽  
Author(s):  
Hsing-Yu Weng ◽  
Anna S Cohen ◽  
Christoph Schankin ◽  
Peter J Goadsby
Keyword(s):  
Controlled Trial ◽  
Clinical Manifestations ◽  
Primary Headache ◽  
Outcome Data ◽  
Short Term ◽  
Autonomic Symptoms ◽  
Primary Headache Disorders ◽  
Cranial Autonomic Symptoms ◽  
History Of

Background 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 two rare headache syndromes classified broadly as Trigeminal Autonomic Cephalalgias (TACs). Methods Here, 65 SUNCT (37 males) and 37 SUNA (18 males) patients were studied to describe their clinical manifestations and responses to treatment. Results Pain was almost always unilateral and side-locked. There were three types of attack: Single stabs, stab groups, and a saw-tooth pattern, with some patients experiencing a mixture of two types. As to cranial autonomic symptoms, SUNA patients mainly had lacrimation (41%) and ptosis (40%). Most cases of the two syndromes had attack triggers, and the most common triggers were touching, chewing, or eating for SUNCT, and chewing/eating and touching for SUNA. More than half of each group had a personal or family history of migraine that resulted in more likely photophobia, phonophobia and persistent pain between attacks. For short-term prevention, both syndromes were highly responsive to intravenous lidocaine by infusion; for long-term prevention, lamotrigine and topiramate were effective for SUNCT, and lamotrigine and gabapentin were efficacious in preventing SUNA attacks. A randomized placebo-controlled cross-over trial of topiramate in SUNCT using an N-of-1 design demonstrated it to be an effective treatment in line with clinical experience. Conclusions SUNCT and SUNA are rare primary headache disorders that are distinct and very often tractable to medical therapy.

Prevalence of cranial autonomic parasympathetic symptoms in chronic migraine: Usefulness of a new scale

Cephalalgia ◽  
2015 ◽  
Vol 36 (4) ◽  
pp. 346-350 ◽  
Author(s):  
Nuria Riesco ◽  
Angel I Pérez-Alvarez ◽  
Laura Verano ◽  
Carmen García-Cabo ◽  
Juana Martínez-Ramos ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Nasal Congestion ◽  
Primary Headaches ◽  
Conjunctival Injection ◽  
Autonomic Symptoms ◽  
Cranial Autonomic Symptoms ◽  
Eyelid Oedema ◽  
Headache Clinic ◽  
First Time ◽  
New Criteria

Background Cranial autonomic symptoms (CAS) seem to appear in around half of migraine patients. Objective Our aim was to analyse the prevalence and profile of CAS, mainly of cranial autonomic parasympathetic symptoms (CAPS), in a series of patients with chronic migraine (CM) according the new criteria for autonomic symptoms in the current IHS classification. Patients and methods We recruited consecutive CM patients attending our headache clinic. Five CPAS were surveyed: lacrimation, conjunctival injection, eyelid oedema, ear fullness and nasal congestion. They were graded as 0 (absent), 1 (present and mild) and 2 (present and conspicuous); therefore the score in this CAPS scale ranges from 0 to 10 points. As a cranial autonomic sympathetic symptom (CSAS), we also asked about the presence of ptosis. Results We interviewed 100 CM patients. Their mean age was 45 years (18–63 years); 93 were females. Eighteen had no CAPS, while 82 reported at least one CAPS. There were only six patients with scores higher than 5, the mean and median CAPS being 2.1 and 2, respectively. Prevalence of CAPS was lacrimation (49%), conjunctival injection (44%), eyelid oedema (39%), ear fullness (30%) and nasal congestion (20%). Ptosis was reported by 42. Conclusion These results, by using for the first time an easy quantitative scale, confirm that (mild) CAPS are not the exception but the rule in CM patients. The score in this CAPS scale could be of help as a further endpoint in clinical trials or to be correlated with potential biomarkers of parasympathetic activation in primary headaches.

scholarly journals Orofacial pain resembling hypnic headache: A case report

2020 ◽  
Vol 3 ◽  
pp. 251581632096278
Author(s):  
Noboru Imai ◽  
Asami Moriya ◽  
Eiji Kitamura
Keyword(s):  
Case Report ◽  
Diagnostic Criteria ◽  
Orofacial Pain ◽  
Primary Headache ◽  
International Classification ◽  
Hypnic Headache ◽  
Autonomic Symptoms ◽  
Cranial Autonomic Symptoms ◽  
Pain Area

The International Classification of Orofacial Pain (ICOP) classifies orofacial pain resembling primary headache as orofacial migraine and tension-type, trigeminal autonomic, and neurovascular orofacial pain. We used the ICOP classification style to make a diagnosis on a 76-year-old woman with orofacial pain, which developed only during sleep three times per week, caused awakening, and lasted 3–4 h without cranial autonomic symptoms or restlessness. Except for the pain area, her symptoms fulfilled the diagnostic criteria for hypnic headache. We diagnosed her with orofacial pain resembling hypnic headache. We should review the cases of such patients and classify them according to the ICOP.

SUNCT, SUNA and pituitary tumors: Clinical characteristics and treatment

Cephalalgia ◽  
2012 ◽  
Vol 33 (3) ◽  
pp. 160-170 ◽  
Author(s):  
Prin Chitsantikul ◽  
Werner J Becker
Keyword(s):  
Clinical Characteristics ◽  
Pituitary Tumors ◽  
Management Program ◽  
Temporal Region ◽  
Conjunctival Injection ◽  
Tumor Removal ◽  
Autonomic Symptoms ◽  
Major Improvement ◽  
Cranial Autonomic Symptoms ◽  
Headache Assessment

Background 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 types of trigeminal autonomic cephalalgias (TACs). Objective To describe a series of patients with SUNCT and SUNA including relationship to pituitary tumors. Method All patients diagnosed with SUNCT or SUNA in the Calgary Headache Assessment and Management Program were reviewed. Results Six patients (five SUNCTs and one SUNA) were identified. The pain was severe, sharp, showed fixed-laterality, involved mainly the orbito-fronto-temporal region and was associated with autonomic symptoms. Attack duration ranged from 3 to 300 seconds and frequency was 1–200 paroxysms/day. MRI showed ipsilateral pituitary adenomas to the pain in five out of five of the SUNCT patients. Patients with adenomas underwent surgery. Pathology included three prolactinomas, and one mixed adenoma and gangliocytoma. One patient has remained headache free for 4 years after surgery. One was pain free for a year, and then headaches returned with tumor recurrence. Another had major improvement, and two have not improved. Patients were generally refractory to medications. Conclusion All five of our patients with typical SUNCT had pituitary tumors, with headache ipsilateral to the pituitary tumors in all cases. Tumor removal provided major improvement in three out of five patients. Medical treatment was only partially effective.

THUR 084 Cranial autonomic symptoms in cluster headache induced by nitroglycerin

2018 ◽  
Vol 89 (10) ◽  
pp. A9.3-A9
Author(s):  
DY Wei ◽  
PJ Goadsby
Keyword(s):  
Cluster Headache ◽  
Nasal Congestion ◽  
Ethics Committee ◽  
Conjunctival Injection ◽  
Headache Attack ◽  
Autonomic Symptoms ◽  
Cranial Autonomic Symptoms ◽  
Cluster Headache Attack ◽  
Episodic Cluster Headache ◽  
Periorbital Swelling

IntroductionCluster headache (CH) is characterised by attacks of unilateral excruciating headache, ipsilateral cranial autonomic symptoms (CAS) and/or agitation. Studying of CAS can further our understanding of CH pathophysiology, but is limited by the episodic nature of the disease. Nitroglycerin (NTG) is known to induce CH. The aim of this study is to characterise CAS induced by NTG.MethodsCH patients received intravenous NTG 0.5 mcg/kg/min over 20 min. CAS and headache phenotype were recorded. The study was approved by the NHS Research Ethics Committee.ResultsTwenty-three patients participated: 83% male and 61% episodic cluster headache. The most common spontaneous CAS reported were lacrimation, nasal congestion and conjunctival injection. Agitation was reported in 96%. Nitroglycerin induced ipsilateral CAS in 91% of the patients, with 74% with ipsilateral pain. Most commonly induced CAS were nasal congestion, lacrimation and periorbital swelling. Agitation was reported in 61%. The majority of the CAS (80%) induced by NTG presented before the onset of severe pain.ConclusionWe demonstrate that NTG effectively triggers ipsilateral cranial autonomic symptoms in CH patients and that they often present in a phase before the onset of pain reflecting the underlying pathways during a cluster headache attack.

scholarly journals Dramatic response of intravenous lidocaine in a patient with status like SUNA

2018 ◽  
Vol 1 ◽  
pp. 251581631880481 ◽  
Author(s):  
Debashish Chowdhury ◽  
Ashish Duggal ◽  
Arun Koul ◽  
Ankur Gupta
Keyword(s):  
Relevant Literature ◽  
Sustained Response ◽  
Primary Headaches ◽  
Conjunctival Injection ◽  
Intravenous Lidocaine ◽  
Autonomic Symptoms ◽  
Cranial Autonomic Symptoms

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 primary headaches that can sometimes present with a status like pattern which can be highly disabling. Intravenous (IV) lidocaine has been reported to be useful in status like SUNCT but its use in status like SUNA remains unexplored. We report a patient of episodic SUNA who despite on multiple conventional drugs had status like presentation. He had an excellent sustained response to IV lidocaine. Relevant literature on treatment of status like SUNCT/SUNA is briefly reviewed. IV lidocaine can be a very useful treatment for status like SUNA.

Trigeminal Neuralgia with Lacrimation Or Sunct Syndrome?

Cephalalgia ◽  
1998 ◽  
Vol 18 (2) ◽  
pp. 85-90 ◽  
Author(s):  
R Benoliel ◽  
Y Sharav
Keyword(s):  
Differential Diagnosis ◽  
Trigeminal Neuralgia ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Intimate Relationship ◽  
The Other ◽  
Conjunctival Injection ◽  
Sunct Syndrome ◽  
Clinical Signs And Symptoms

An intimate relationship between trigeminal neuralgia (TN) and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome, based on similar clinical signs and symptoms and on cases demonstrating possible “transformation” from one entity to the other, has been widely accepted. We evaluated the presence of lacrimation in 22 consecutive cases that had been diagnosed as TN. Ipsilateral lacrimation was reported by 6 such cases (5M, 1F). These cases responded to antineuralgic therapy with concomitant resolution of lacrimation and were clinically very similar to TN. The differential diagnosis and the possibility of lacrimation in TN are discussed.

Post-Traumatic Short-Lasting Unilateral Headache With Cranial Autonomic Symptoms (SUNA)

Cephalalgia ◽  
2008 ◽  
Vol 28 (9) ◽  
pp. 991-993 ◽  
Author(s):  
S Jacob ◽  
AR Saha ◽  
YA Rajabally
Keyword(s):  
Head Injury ◽  
International Headache Society ◽  
Trigeminal Autonomic Cephalalgias ◽  
Conjunctival Injection ◽  
Traumatic Head Injury ◽  
Autonomic Symptoms ◽  
Cranial Autonomic Symptoms ◽  
Unilateral Headache ◽  
Traumatic Head ◽  
Post Traumatic

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome is a rare headache syndrome classified among the trigeminal autonomic cephalalgias. It is usually idiopathic, although infrequent secondary forms have been described. Recently the term short-lasting unilateral headache with cranial autonomic symptoms (SUNA) has been defined by the International Headache Society (ICHD-2) as similar to SUNCT with less prominent or absent conjunctival injection and lacrimation. We report two patients with paroxysmal orbito-fronto-temporal pains, phenotypically suggesting SUNA, occurring after traumatic head injury.

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