SUNCT: The Rarest Primary Headache in Indian Perspective

Case Report

Austin J Clin Case Rep. 2014;1(2): 1009.

SUNCT: The Rarest Primary Headache in Indian Perspective

Jain RS1, Prakash S1*, Handa R1 and Nagpal K1

1Department of Neurology, SMS Medical College & attached Hospital, India

*Corresponding author: Prakash S, Department of Neurology, SMS Medical College & attached Hospitals, RUHS, Jaipur.302, Gayatri apartments, Khanjarpur, Bhagalpur, India

Received: May 28, 2014; Accepted: June 12, 2014; Published: June 14, 2014

Keywords

Short lasting unilateral neuralgiform headache with conjunctival injection and tearing; Primary headache; Trigeminal autonomic cephalgias; Paroxysmal hemicranias; Cluster headache; Trigeminal neuralgia

Abbreviations

SUNCT: Short lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing; TAC: Trigeminal Autonomic Cephalgias; PH: Paroxysmal Hemicranias; CH: Cluster Headache; TN: Trigeminal Neuralgia; MRI: Magnetic Resonance Imaging; DBS: Deep Brain Stimulation

Introduction

Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is a very rare primary headache, characterized by brief paroxysm of agonizing unilateral orbital or periorbital pain, associated with marked autonomic symptoms [1]. It was first described in 1978 by Sjaastad [2], and was classified among the subclasses of Trigemino-autonomic-cephalgias (TAC) by the International Headache Society (IHS) in 2004 [3]. However, owing to its rarity and overlap with the symptoms of Trigeminal Neuralgia (TN), Paroxysmal Hemicranias (PH) and Cluster Headache (CH), it is liable to be misdiagnosed and wrongly treated. Here we are reporting a series of nine cases of SUNCT from northern India, discussing the demographic and clinical details experienced at our centre; with the aim to highlight its distinguishing features, thus facilitating prompt diagnosis and management.

Materials and Methods

This observational study was conducted at SMS Medical college Hospital, Jaipur; a large teaching hospital of northern India, over a period of 10 years. All patients presenting with brief paroxysm of unilateral craniofacial pain and autonomic symptoms were considered for further clinico-historical evaluation of attacks; in terms of frequency, duration, location, severity, trigger ability, and response to any previous medication. A final diagnosis was made only after thorough neuro-ophthalmological examination, neuroimaging, and applying IHS diagnostic criteria for SUNCT (Table 1). A total of 89 patients were taken for evaluation, of which only 9 patients were finally diagnosed as SUNCT.