Neuro Diseases: SUNCT Headache Syndrome

Introduction

SUNCT Headache Syndrome which is the abbreviation for "Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing" is quite a lengthy name for such a very short duration headache condition.

With this condition the headache (HA) as the name implies lasts only for a short duration, the range being from about 5 seconds to 250 seconds. Although this is the range majority of them last for 10 to 120 seconds and the mean duration is about 60 seconds or just one minute.

Although the duration is brief but many of these attacks are severe in nature. They hit you abruptly and as if stabbed with something, or jolted with an electric shock.

Some characteristic features of this syndrome include;

• The individual attacks are confined to only one side of the head
• Involve the eye and around the eye region
• Majority of the sufferers are men
• Almost all attacks seem to occur during day time
• Age of onset is around fifty years

The frequency varies, from just a single episode to 40-50 episodes can occur per day.

What causes this Headache?

This is a primary headache syndrome, means there are no structural problems in the brain or no known any kind of problems out side the brain locally or systemically to explain the headache.

Clinical Manifestations

Along with the above mentioned characteristic features patients also exhibit prominent autonomic features like conjunctival reddening (injection), abnormal tearing, rhinorrhea (abnormal nasal secretion), swelling of the eyelids, forehead flushing etc. Pupil size doesn’t change during these headache episodes.

Diagnosis

The diagnosis is accomplished based on clinical criteria. Imaging study of the brain like a CT or MRI are generally not required however if any dilemma is there as to what is causing the HA then such investigations are necessary.

Treatment

Since the attacks are brief in duration it is difficult to treat them. By the time you take the pill and its effect kicks in the headache is gone already.

However if patients get clustering of episodes then something is necessary, also as a preventive agent when these episodes occur frequently.

These episodes do not respond to indomethacin. Actually there is no single drug that has found to be consistently effective for the management of this type of HA,. If several episodes are happening (clustering) then we could try some NSAID like celecoxib, naproxen, diclofenac etc. If they are not helpful then a short course of opioids or steroids can be tried with all the precautions.

For prevention purpose patients can try medications like carbamazepine, gabapentin, lamotrigine, steroids etc.

A neurologist is frequently involved in the care of patients with SUNCT Headache Syndrome.



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