SUNCT/SUNA and neurovascular compression: New cases and critical literature review

IRCCS Institute of Neurological Sciences of Bologna, Headache Centre, Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
Cephalalgia (Impact Factor: 4.89). 06/2013; 33(16). DOI: 10.1177/0333102413494273
Source: PubMed


Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with cranial autonomic symptoms (SUNA) are primary headache syndromes. A growing body of literature has focused on brain magnetic resonance imaging (MRI) evidence of neurovascular compression in these syndromes.
The objective of this article is to assess whether SUNCT is a subset of SUNA or whether the two are separate syndromes and clarify the role of neurovascular compression.
We describe three new SUNCT cases with MRI findings of neurovascular compression and critically review published SUNCT/SUNA cases.
We identified 222 published SUNCT/SUNA cases. Our three patients with neurovascular compression added to the 34 cases previously described (16.9%). SUNCT and SUNA share the same clinical features and therapeutic options. At present, there is no available abortive treatment for attacks. Lamotrigine was effective in 64% of patients; topiramate and gabapentin in about one-third of cases. Of the 34 cases with neurovascular compression, seven responded to drug therapies, 16 patients underwent microvascular decompression of the trigeminal nerve (MVD) with effectiveness in 75%.
We suggest that SUNCT and SUNA should be considered clinical phenotypes of the same syndrome. Brain MRI should always be performed with a dedicated view to exclude neurovascular compression. The high percentage of remission after MVD supports the pathogenetic role of neurovascular compression.

Download full-text


Available from: Daniela Grimaldi,
98 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clusterkopfschmerz, paroxysmale Hemikranie und ,,short-lasting unilateral neuralgiform headache attacks with conjuntival injection and tearing“ (SUNCT-Syndrom) werden unter den trigeminoautonomen Kopfschmerzerkrankungen (,,trigemino autonomic cephalalgia; TAC) zusammengefasst. Die neue vorgeschlagene internationale Klassifikation der Kopfschmerzerkrankungen (ICDH-3 beta) zählt nun auch die Hemicrania continua zu dieser Gruppe, außerdem wurden die Diagnosekriterien der anderen TACs modifiziert. TACs sind durch ständige oder in Attacken auftretende Kopfschmerzen mit zusätzlichen kranial autonomen Begleitsymptomen charakterisiert. Sie unterscheiden sich in ihrer Attackendauer und müssen wegen unterschiedlicher pharmakologischer Therapiestrategien voneinander abgegrenzt werden.
    Der Nervenarzt 12/2013; 84(12). DOI:10.1007/s00115-012-3624-4 · 0.79 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Medically refractory headache is an uncommon but difficult-to-treat clinical problem. Patients who fail maximal medical management may be candidates for invasive treatment. In this review, we critically examine the literature on the range of surgical treatments currently available for migraine, trigeminal autonomic cephalalgias, idiopathic intracranial hypertension and Chiari malformation type 1, with particular attention to patient selection, treatment efficacy, and complications.
    Headache The Journal of Head and Face Pain 02/2014; 54(3). DOI:10.1111/head.12294 · 2.71 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with medically refractory headache disorders are a rare and challenging-to-treat group. The introduction of peripheral neurostimulation (PNS) has offered a new avenue of treatment for patients who are appropriate surgical candidates. The utility of PNS for headache management is actively debated. Preliminary reports suggested that 60-80% of patients with chronic headache who have failed maximum medical therapy respond to PNS. However, complications rates for PNS are high. Recent publication of 2 large randomized clinical trials with conflicting results has underscored the need for further research and careful patient counseling. In this review, we summarize the current evidence for PNS in treatment of chronic migraine, trigeminal autonomic cephalagias and occipital neuralgia, and other secondary headache disorders.
    Headache The Journal of Head and Face Pain 02/2014; 54(3). DOI:10.1111/head.12292 · 2.71 Impact Factor
Show more