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Topic: SUNCT Syndrome (Read 759 times) |
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Shadow
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SUNCT Syndrome
« on: Apr 4th, 2003, 12:19pm » |
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Anyone know a good place to find out more info on this? After doing some reading, I have found that this best reads like I fell!! Anyone with some info on this would be great.
Thank you.
Chad
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firebrix
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Re: SUNCT Syndrome
« Reply #1 on: Apr 4th, 2003, 2:23pm » |
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I did a Google search and found many linx there Shadow.
There are other search engines that cover medical matters more specifically - hopefully someone will direct you as I can't find the linx and have to go to work.
Hope you have a good day
firebrix
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BILLY
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http://www.google.com web searches are always good. You might also want to go to http://www.pubmed.gov & type in SUNCT to read the latest published titles & abstracts. SUNCT appears to be more of an irregular paroxysmal condition (that may not be initiated by the hypothalamus as suspected in CH since attacks do not seem to follow any predictable cyclical patterns) & actually worsened by verapamil with a few case reports of reponse to anticonvulsants (sometimes complete remissions to lamotrigine & gabapentin) & surgery for treatment refractory cases.
Example of Pubmed search:
SUNCT Syndrome: diagnosis and treatment.
Headache 2003 Mar;43(3):306
Pareja J, Caminero A, Sjaastad O.
CNS Drugs. 2002;16(6):373-383 Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT) is a syndrome predominant in males, with a mean age of onset around 50 years. The attacks are strictly unilateral, generally with the pain persistently confined to the ocular/periocular area. Most attacks are moderate to severe in intensity and burning, stabbing or electrical in character. The mean duration of paroxysms is 1 minute, with a usual range of 10 to 120 seconds (total range 5 to 250 seconds). Prominent, ipsilateral conjunctival injection and lacrimation regularly accompany the attacks. Nasal stuffiness/rhinorrhoea are frequently noted. In addition, there is subclinical forehead sweating. During attacks, there is increased intraocular pressure on the symptomatic side and swelling of the eyelids. No changes in pupil diameter have been observed. Attacks can be triggered mostly from trigeminally innervated areas, but also from the extratrigeminal territory. There are also spontaneous attacks. An irregular temporal pattern is the rule, with symptomatic periods alternating with remissions in an unpredictable fashion. During active periods, the frequency of attacks may vary from <1 attack/day to>30 attacks/hour. The attacks predominate during the daytime, nocturnal attacks being seldom reported. A SUNCT-like picture has been described in some patients with either intra-axial or extra-axial posterior fossa lesions, mostly vascular disturbances/ malformations. In the vast majority of patients, however, aetiology and pathogenesis are unknown. In SUNCT syndrome, there is a lack of persistent, convincingly beneficial effect of drugs or anaesthetic blockades that are generally effective in cluster headache, chronic paroxysmal hemicrania, trigeminal neuralgia, idiopathic stabbing headache (Ajabs and jolts syndrome'), and other headaches more faintly resembling SUNCT syndrome. Single reports have claimed that carbamazepine, lamotrigine, gabapentin, corticosteroids or surgical procedures may be of help. However, caution is recommended when assessing any therapy in a disorder such as SUNCT syndrome, in which the rather chaotic and unpredictable temporal pattern makes the assessment of any drug/therapeutic effect per se a particularly difficult matter. Comment: Another excellent review article. If you want to learn about the rare, short trigeminal autonomic cephalgia (TAC), this is a thorough and thoughtful place to start. SJT
PMID: 12603673 [PubMed - as supplied by publisher]
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BILLY
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Occasionally there are links to the full articles like the somewhat dated 1997 but still excellent article by Dr. Goadsby introducing the TACs as a classification group with Differential diagnosis & proposed criteria for short lasting headaches (including SUNCT although in 1997 there were no established treatments for it):
Brain 1997 Jan;120 ( Pt 1):193-209
A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic feature, including new cases.
http://brain.oupjournals.org/cgi/reprint/120/1/193.pdf
(You will need Acrobat free reader if you don't already have it at http://www.adobe.com/products/acrobat/readstep2.html)
Goadsby PJ, Lipton RB.
Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
The short-lasting primary headache syndromes may be conveniently divided into those exhibiting marked autonomic activation and those without autonomic activation. The former group comprise chronic and episodic paroxysmal hemicrania, short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome) and cluster headache. These headache syndromes are compared with other short-lasting headache disorders, such as hypnic headache, and persistent headache with milder autonomic features such as hemicrania continua. Cluster headache is included with the shorter-lasting headaches to attempt a nosological analysis of these syndromes. The paroxysmal hemicranias are characterized by frequent short-lasting attacks of unilateral pain usually in the orbital, supraorbital or temporal region that typically last minutes. The attack frequency usually ranges from 5 to 40 attacks per day. The pain is severe and associated with autonomic symptoms such as conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, ptosis or eyelid oedema. Almost all reported cases respond to treatment with indomethacin, but respond poorly to other treatments including other nonsteroidal anti-inflammatory drugs. A recent case study demonstrated the release of both trigeminal and parasympathetic neuropeptides during a bout of pain in the same pattern previously described in cluster headache. The SUNCT syndrome is a distinctive rare condition characterized by less severe pain but marked autonomic activation during attacks. Consistent with previous reports, the present case of SUNCT syndrome was intractable to therapy. The similarites of these syndromes suggests a considerable shared pathophysiology. It is suggested that the syndromes are sufficiently well established for inclusion in the International Headache Society Classification system and that trigeminal-autonomic cephalalgias should be classified as a group together. A proposed re-classification is presented.
PMID: 9055807 [PubMed - indexed for MEDLINE]
Example of goggle search:
You might find this site useful for broad overview:
http://www.upstate.edu/neurology/haas/
Diagnosis and treatment of headaches and migraines
by David C Haas, MD, neurologist / headache specialist
SUNY Upstate Medical University, Syracuse, New York, USA
http://www.achenet.org/news/older/122001.php
SUNCT syndrome can be successfully treated with the anti-seizure drug lamotrigine, according to a case report in the November 13 issue of Neurology. SUNCT syndrome is an extremely rare, one-sided, stabbing headache, with attacks lasting only seconds but occurring many times per day. Usually the headache is accompanied by tearing and reddening of the eye. It is generally not responsive to treatment, but lamotrigine has been reported to be successful in three cases reported over the last 3 years. In this latest report, Italian investigators successfully treated five sequential new cases of SUNCT syndrome with lamotrigine (125- 200 mg daily). Three patients achieved complete remission; the other two patients experienced a substantial reduction (about 80%) of attack frequency.
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Mark C
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Re: SUNCT Syndrome
« Reply #4 on: Apr 4th, 2003, 7:44pm » |
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Look Here
SUNCT
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MarkV
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Re: SUNCT Syndrome
« Reply #5 on: Apr 6th, 2003, 3:50pm » |
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Wish I knew more to tell you other than the posts you got so far in your thread. I have SUNCT symptoms in addition to more "traditional" CH symptoms. My SUNCT symptoms surfaced more when I started verapamil for the bad CHs I was getting. I thought cool, I can deal with these short ice picks instead of the skull cracking clusters... until now.
Lately the clusters started breaking through my depakote verapamil cocktail and the SUNCT ice picks are going out of control too. I was up to 100+ stabs a day until I recently took a dose pack of prednisone and followed it with topamax. The topamax has been helping I think, but I'm having a little difficulty coping with the side effects.
If the topamax keeps working and I can increase it to 100mg without wigging out, I'm willing to give it a shot. Fingers crossed.... 
Mark
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Shadow
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Re: SUNCT Syndrome
« Reply #6 on: Apr 7th, 2003, 9:56am » |
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Thanks for all the info, I will be looking in to all of the stuff you have posted. I have found a few things, and it looks like all of you have found different sites than I did witch is good. Thanks again.
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Bob P
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Re: SUNCT Syndrome
« Reply #7 on: Apr 7th, 2003, 11:35am » |
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Go here and scroll about half way through the article to the SUNCT section:
http://www.clusterheadaches.org/library/general/ch_general.htm
Good old OUCH Library!
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Azrael
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Re: SUNCT Syndrome
« Reply #8 on: Apr 19th, 2003, 8:34pm » |
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MarkV... What you're gettin' may not be SUNCT... The ice pick headaches may be primary stabbing headaches:
(From: IHC 2nd Ed. final rough draft)
4.1. Primary stabbing headache
Previously used term: Ice-pick pains, jabs and jolts, ophtalmodynia periodica
Description: Transient stabs of pain in the head that occur spontaneously in the absence of organic disease of underlying structures or of the cranial nerves.
Diagnostic criteria:
A. Pain occurring as a single stab or a series of stabs confined to the head and exclusively or predominantly felt in the distribution of the first division of the trigeminal nerve (orbit, temple and parietal area).
B. Each stab lasts for up to few seconds.
C. Stabs recur with a frequency ranging from one to many per day, in rare cases they occur repetitively over days.
D. No accompanying symptoms.
E. Not attributed to another disorder.
Comment: In a single published descriptive study, 80% of the stabs lasted 3 seconds or less. The occurrence in status lasting up to one week (active period) was reported. Stabbing pains are more commonly experienced by people subject to migraine (about 40%) and cluster headache (about 30%), in which case they are felt in the site habitually affected by headache. Stabs may change from one area to the next in either the same or the opposite hemicranium. When strictly localized in one particular area, diagnosis depends upon the exclusion of structural changes at the site of pain and in the distribution of the affected cranial nerve. Positive response to the indomethacin administration is reported in non controlled studies.
Shadow... Dunno if you've seen the IHS guidelines for SUNCT yet or not, but here they are:
(From: IHC 2nd Ed. final rough draft)
3.3 Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing(SUNCT)
Previously used terms: This syndrome was described after the publication of the last classification (29) and has become well recognized in the last decade (30).
Description: The syndrome is characterized by short-lasting attacks of unilateral pain that are much briefer than seen in any other TAC and most often associated with a prominent lacrimation and redness of the ipsilateral eye. There is no substantial evidence in the literature for episodic SUNCT. The literature suggests that the most common mimic of SUNCT would be a lesion in the posterior fossa (31-33).
Diagnostic criteria
A. At least 20 attacks fulfilling B-E
B. Attacks of unilateral orbital, or temporal stabbing, or throbbing pain lasting from 10-120secs
C. Attack frequency from 3 to 200/day
D. Pain is associated with conjunctival injection and lacrimation.
E. Not attributed to another disorder
PFDAN.................................. Drk^Angel
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| « Last Edit: Apr 19th, 2003, 8:35pm by Azrael » |
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Shadow
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Re: SUNCT Syndrome
« Reply #9 on: May 14th, 2003, 9:57am » |
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Thanks for the info, that does sound more like what I have and get. The Doctor has put me on Idernal 80mg a day and Imatrax for if I get any more of them. So far they seem to be helping.
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