Abstract：
OPINION STATEMENT:The problem of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) management remains unsolved. Despite a myriad of therapeutic trials, no convincingly effective remedy for SUNCT and SUNA is available at present. Based on open-label communications, some patients seemed to benefit from some pharmacologic, interventional, or invasive procedures. Possible effective preventive drugs are carbamazepine, lamotrigine, gabapentin, and topiramate. At present, the drug of choice for SUNCT seems to be lamotrigine whereas SUNA may better respond to gabapentin. There is no available abortive treatment for the individual attacks. During the worst periods, intravenous lidocaine may decrease the flow of SUNCT/SUNA attacks. In SUNCT, bilateral blockade of the greater occipital nerve, and superior cervical ganglion opioid blockade have been reported as temporary/partially effective in one patient each. Botulinum toxin injected around the symptomatic orbit provided sustained relief to one patient. Owing to the scarcity of reports the results of these interventions should be taken as preliminary. Invasive therapy with interventions directed to the first division of the trigeminal nerve or Gasserian ganglion, with local anesthetics or alcohol, radiofrequency thermocoagulation, microvascular decompression, and gamma-knife neurosurgery, have been tried in the treatment of refractory SUNCT. Some patients seemed to benefit from such interventions, but one should still have a critical attitude to these claims since no convincing results have been obtained as yet. The few SUNCT patients who underwent deep brain hypothalamic stimulation obtained a substantial and persistent relief.
journal_name
Curr Treat Options Neuroljournal_title
Current treatment options in neurologyauthors
Pareja JA,Alvarez M,Montojo Tdoi
10.1007/s11940-012-0211-8subject
Has Abstractpub_date
2013-02-01 00:00:00pages
28-39issue
1eissn
1092-8480issn
1534-3138journal_volume
15pub_type
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journal_title：Current treatment options in neurology
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journal_title：Current treatment options in neurology
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journal_title：Current treatment options in neurology
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journal_title：Current treatment options in neurology
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journal_title：Current treatment options in neurology
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journal_title：Current treatment options in neurology
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journal_title：Current treatment options in neurology
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journal_title：Current treatment options in neurology
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journal_title：Current treatment options in neurology
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更新日期：2012-08-01 00:00:00
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journal_title：Current treatment options in neurology
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journal_title：Current treatment options in neurology
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journal_title：Current treatment options in neurology
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journal_title：Current treatment options in neurology
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journal_title：Current treatment options in neurology
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journal_title：Current treatment options in neurology
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