REVIEW ARTICLE


Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) Status Like Condition: A Rare Case Report and Review of the Literature.



Jayanti K Gurumukhani1, Dhruvkumar M. Patel2, Mukundkumar V. Patel3, *, Maitri M. Patel4, Anand V Patel5, Suyog Y Patel6
1 Jay Neurology and physiotherapy clinic, Bhavnagar, India
2 Zydus Medical College, and Hospital, Dahod, India
3 Zydus Medical College and Hospital, Dahod, India
4 GCS Medical College and Hospital Ahmedabad, India
5 University of Texas Medical Branch, Galveston, TXUSA
6 B.J. Medical College, Ahmedabad, India


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Creative Commons License
© 2020 Gurumukhani et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Associate professor in medicine Zydus Medical College and Hospital, Dahod, Gujarat, India;
Tel: +919909013760 E-mail: drmukundvpatel123@yahoo.co.in


Abstract

Background:

SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) is rare trigeminal autonomic cephalgia characterized by recurrent, brief, excruciating unilateral, intermittent headache paroxysms over orbital, frontal or temporal region occurring multiple times per day and it can rarely present as “SUNCTstatus like condition” (SSLC).

Case Report:

A 28-year old male with a history of SUNCT headache for 6 months presented with left forehead stabs lasting for 30 seconds with a frequency of 40-45 episodes per hour for three days followed by infective gastroenteritis. His neurological examination was normal, except left-sided ptosis, tearing, and conjunctival injection. His MRI brain with contrast, MR angiography, and laboratory investigations were unremarkable except mild hypokalemia. He was treated with intravenous fluids, potassium replacement, and high dose methylprednisolone along with an escalated dose of carbamazepine.

Review and Conclusion:

We have reviewed the previously reported seven cases and our case of SSLC. Female: Male ratio was 3:1and the mean age was 40.87 years. Three patients responded to high dose steroids and three to lignocaine along with rapid escalation or change of anticonvulsant drugs. One case responded to the high dose of lamotrigine, and in a pregnant lady, the pain subsided only after the termination of the pregnancy. One case was secondary to multiple sclerosis, while the rest of seven were primary episodic SSLC. The condition is highly disabling, and the treatment with steroids or lignocaine, along with the rapid escalation of preventive drugs, can provide long-lasting relief

Keywords: SUNCT, Short-lasting unilateral neuralgiform headache, SUNCT status like condition, Headache, Methylprednisolone, Lidocaine, Carbamazepine.