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

Hsing Yu Weng, Anna S. Cohen, Christoph Schankin, Peter J. Goadsby

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

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.

Original languageEnglish
JournalCephalalgia
DOIs
Publication statusAccepted/In press - Jan 1 2017

Keywords

  • cranial autonomic symptoms
  • gabapentin
  • lamotrigine
  • lidocaine
  • SUNA
  • SUNCT
  • topiramate
  • trigeminal autonomic cephalalgia
  • triggers

ASJC Scopus subject areas

  • Clinical Neurology

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