A Case Of Early-onset And Monthsophasic Trigeminal Autonomic Cephalalgia: Could It Be A Sunct?
Sciruicchio, V., Sardaro, M., Gagliardi, D., Trabacca, A., Galeone, D., & de Tommaso, M. (2010). A case of early-onset and monthsophasic trigeminal autonomic cephalalgia: could it be a SUNCT?. The journal of headache and pain, 11(4), 363–365. https://doi.org/10.1007/s10194-010-0219-y
View Original Source →Abstract
A 2-year-old female came to the Neurological Emergency Room of “Giovanni XXIII” Hospital in Bari, 6 h after the onset of severe facial pain, which occurred soon after awakening. Stabbing pain affected the right frontal and periorbital area, with ipsilateral conjunctival injection, swelling of the eyelids and tearing. Except the duration, from 5 to 30 s., the attacks were stereotyped including the occurrence and features of autonomic signs. Based on the typical clinical findings and the normal magnetic resonance imaging (MRI), we diagnosed short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome (SUNCT). The spontaneous remission within a few hours made prophylactic therapy unnecessary. At the last follow-up, after 3 months, the patient was still symptom free. In our case, after an active period lasting 2 days the disease disappeared completely. However the typical features of the disease (unilateral pain, short duration and high frequency of the attacks, autonomic signs ipsilateral to pain, numbers of attacks) were all present. While the diagnostic criteria of the International Headache Society classification for SUNCT did not include the duration of disease, it is likely that the active period lasting 2 days could be an expression of the clinical variability of the disease.
Case Details
Disease Location
Pns
Personal Characteristics
2 -year-old italian female mother had no complaints during the pregnancy and delivery no first degree inheritance for primary headaches or trigeminal autonomic cephalalgias (tacs)
Clinical Characteristics
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome (sunct) admitted with severe facial pain after awakening, stabbing pain affected the right frontal and periorbital area, with ipsilateral conjunctival injection, swelling of the eyelids and tearing the first exam consisted of a pain attack with an incomplete patientosis of the right eye with impressive ipsilateral conjunctival injecting and tearing. The patient repeatedly beat her right frontal and periorbital regions, implicating the location attacks lasted 25 secs (5s - 30s) after which she was pale and tired, she present 40 more attacks during the afternoon usually after a nap and disappearing during night sleep, the next morning there were 10 attacks concentrated in the first hour awake attacks recurred in a single stab (from 1 - 6 an hour) with a total of more than 40 attacks awakening seemed to be the precipitating mechanism development was normal, physical and neurological exams, ocular exams were all normal eeg during critical period was normal cranium MRI and angiography MRI were normal and sunct was primary diagnosis
Remission Characteristics
A few hours after remission occurred. After two days the sunct had resolved completely except there was still unilateral pain, short duration and high frequency of the attacks, autonomic sign ipsilateral to pain, numbers of attacks 3 months later, still symptom free
Treatment & Mechanisms
Proposed Remission Mechanisms
Might just be clinical variability
Clinical Treatment
None reported
Non-Clinical Treatment
None reported