Current Treatment Options in Neurology

, Volume 15, Issue 1, pp 28–39 | Cite as

SUNCT and SUNA: Recognition and Treatment

  • Juan A. Pareja
  • Mónica Álvarez
  • Teresa Montojo
HEADACHE (JR COUCH, SECTION EDITOR)

Opinion statement

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.

Keywords

SUNCT SUNA Trigeminal neuralgia Trigemino-autonomic cephalgias Carbamazepin Lamotrigine Topiramate Gabapentin Lidocaine Phenytoin Corticosteroids Sumatriptan Greater occipital nerve blockade Superior cervical opioid ganglion blockade Botulinum toxin Trigeminal radiofrequency thermocoagulation Gasserian glycerol ganglyolisis Ballon compression of the trigeminal root Ballon compression of the Gasserian ganglion Trigeminal microvascular decompression Gamma-knife radiosurgery Hypothalamic stimulation 

Notes

Disclosure

No potential conflicts of interest relevant to this article were reported.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Juan A. Pareja
    • 1
    • 2
  • Mónica Álvarez
    • 2
  • Teresa Montojo
    • 2
  1. 1.Department of NeurologyUniversity Hospital Quirón MadridMadridSpain
  2. 2.Department of NeurologyUniversity Hospital Fundación AlcorcónAlcorconSpain

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