SUNCT/SUNA and neurovascular compression: New cases and critical literature review. (December 2013)

• Record Type: Journal Article
• Authors: Favoni, Valentina; Grimaldi, Daniela; Pierangeli, Giulia; Cortelli, Pietro; Cevoli, Sabina
• Is Part Of: Cephalalgia. Volume 33:Number 16(2013)
• Page Start: 1337
• Page End: 1348
• Publication Date: 2013-12
• Subjects: SUNCT -- SUNA -- autonomic -- neurovascular compression -- microvascular decompression; Headache -- Periodicals; 616.8491
• DOI: 10.1177/0333102413494273
• Languages: English
• ISSNs: 0333-1024

Abstract

Background: 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. Objective: 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. Method: We describe three new SUNCT cases with MRI findings of neurovascular compression and critically review published SUNCT/SUNA cases. Results: 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%. Conclusions: 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.