Methylprednisolone therapy for short-term prevention of SUNCT syndrome
A Trauninger,
B Alkonyi, N Kovács, S Komoly, Z Pfund,
A Trauninger
Department of Neurology, University of Pécs, Hungary
Search for more papers by this authorA Trauninger,
B Alkonyi, N Kovács, S Komoly, Z Pfund,
A Trauninger
Department of Neurology, University of Pécs, Hungary
Search for more papers by this authorDr Zoltán Pfund, Department of Neurology, University of Pécs, H-7623 PÉCS, RÉT U. 2, Hungary. E-mail: [email protected]
Abstract
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is characterized by severe and frequent daily pain attacks causing transient physical disability for the patients during the headache period. Currently there is no option for abortive treatment of the attacks, mainly due to the short-lived nature and frequency of the repeated headaches, while highly efficacious therapy is also unavailable for short-term prevention. We report rapidly suppressed headache attacks with orally administered methylprednisolone in eight headache periods of three patients with idiopathic, episodic SUNCT syndrome. The remission was maintained until the period was over in all cases. Although the mechanism of methylprednisolone action is unclear, it is probably based on the anti-inflammatory effects of the drug.
References
- 1 Goadsby PJ, Lipton RB. A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic feature, including new cases. Brain 1997; 120: 193–209.
- 2 Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain (second edition). Cephalalgia 2004; 24: 1–160.
- 3 Benjamin L, Levy MJ, Lasalandra MP, Knight YE, Akerman S, Classey JD, Goadsby PJ. Hypothalamic activation after stimulation of the superior sagittal sinus in the cat: a Fos study. Neurobiol Dis 2004; 16: 500–5.
- 4
Malick A,
Burstein R.
Cells of origin of the trigeminohypothalamic tract in the rat.
J Comp Neurol
1998; 400: 125–44.
10.1002/(SICI)1096-9861(19981012)400:1<125::AID-CNE9>3.0.CO;2-B CAS PubMed Web of Science® Google Scholar
- 5 Bartsch T, Levy MJ, Knight YE, Goadsby PJ. Differential modulation of nociceptive dural input to [hypocretin] orexin A and B receptor activation in the posterior hypothalamic area. Pain 2004; 109: 367–78.
- 6 May A, Bahra A, Büchel C, Frackowiak RS, Goadsby PJ. Hypothalamic activation in cluster headache attacks. Lancet 1998; 351: 275–8.
- 7 May A, Bahra A, Büchel C, Turner R, Goadsby PJ. Functional magnetic resonance imaging in spontaneous attacks of SUNCT: short-lasting neuralgiform headache with conjunctival injection and tearing. Ann Neurol 1999; 46: 791–4.
- 8 Matharau MS, Cohen AS, McGonigle DJ, Ward N, Frackowiak RS, Goadsby PJ. Posterior hypothalamic and brainstem activation in hemicrania continua. Headache 2004; 44: 747–61.
- 9 May A, Leone M, Áfra J, Linde M, Sándor PS, Evers S, Goadsby PJ. EFNS guideline on treatment of cluster headache and other trigeminal autonomic cephalalgias. Eur J Neurol 2006; 13: 1066–77.
- 10 Cohen AS, Matharu MS, Goadsby PJ. Trigeminal autonomic cephalalgias: current and future treatments. Headache 2007; 7: 969–80.
- 11 Matharu MS, Cohen AS, Goadsby PJ. SUNCT syndrome responsive to intravenous lidocaine. Cephalalgia 2004; 24: 985–92.
- 12 Cohen AS. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. Cephalalgia 2007; 27: 824–32.
- 13 Williams MH, Broadley SA. SUNCT and SUNA: clinical features and medical treatment. J Clin Neurosci 2008; 15: 526–34.
- 14 D'Andrea G, Granella F, Cadaldini M. Possible usefulness of lamotrigine in the treatment of SUNCT syndrome. Neurology 1999; 53: 1609.
- 15 D'Andrea G, Granella F, Ghiotto N, Nappi G. Lamotrigine in the treatment of SUNCT syndrome. Neurology 2001; 57: 1723–5.
- 16 Pareja JA, Caminero AB, Sjaastad O. SUNCT syndrome: diagnosis and treatment. CNS Drugs 2002; 16: 373–83.
- 17 Matharu MS, Cohen AS, Boes CJ, Goadsby PJ. Shortlasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome: a review. Curr Pain Headache Rep 2003; 7: 308–18.
- 18 Couch JR Jr, Ziegler DK. Prednisone therapy for cluster headache. Headache 1978; 18: 219–21.
- 19 Ekbom K, Hardebo JE. Cluster headache: pathogenesis, diagnosis, and management. Drugs 2002; 62: 61–9.
- 20 Pareja JA, Kruszewski P, Sjaastad O. SUNCT syndrome: trials of drugs and anesthetic blockades. Headache 1995; 35: 138–42.
- 21 Raimondi E, Gardella L. SUNCT syndrome. Two cases in Argentina. Headache 1998; 38: 369–71.
- 22 Montes E, Alberca R, Lozano P, Franco E, Martinez-Fernandez E, Mir P. Statuslike SUNCT syndrome in two young women. Headache 2001; 8: 826–9.
- 23 De Lourdes Figuerola M, Bruera O, Pozzo MJ, Leston J. SUNCT syndrome responding absolutely to steroids in two cases with different etiologies. J Headache Pain 2009; 10: 55–7.
- 24 Sabatowski R, Huber M, Meuer T, Radbruch L. SUNCT syndrome: a treatment option with local opioid blockade of the superior cervical ganglion? A case report. Cephalalgia 2001; 21: 154–6.
- 25 Cohen AS, Matharu MS, Goadsby PJ. Suggested guidelines for treating SUNCT and SUNA. Cephalalgia 2005; 25: 1200.
- 26 Hunt CH, Dodick DW, Bosch EP. SUNCT responsive to gabapentin. Headache 2002; 42: 525–6.
- 27 Matharu MS, Boes CJ, Goadsby PJ. SUNCT syndrome: prolonged attacks, refractoriness and response to topiramate. Neurology 2002; 58: 1307.
- 28 Rossi P, Cesarino F, Faroni J, Malpezzi MG, Sandrini G, Nappi G. SUNCT syndrome successfully treated with topiramate: case reports. Cephalalgia 2003; 23: 998–1000.
- 29 Black DF, Dodick DW. Two cases of medically and surgically intractable SUNCT: a reason for caution and an argument for central mechanisms. Cephalalgia 2002; 22: 201–4.
- 30 Graff-Radford SB. SUNCT syndrome responsive to gabapentin (Neurontin). Cephalalgia 2000; 20: 515–17.
- 31 Porta-Etessam J, Benito-Leon J, Martinez-Salio A, Berbel A. Gabapentin in the treatment of SUNCT syndrome. Headache 2002; 42: 523–4.
- 32 Calvo JF, Bruera OC, De Lourdes Figuerola M, Gestro D, Tinetti N, Leston JA. SUNCT syndrome: clinical and 12-year follow-up case report. Cephalalgia 2004; 24: 900–2.
- 33 Peres MF, Stiles MA, Siow HC, Rozen TD, Young WB, Silberstein SD. Greater occipital nerve blockade for cluster headache. Cephalalgia 2002; 22: 520–2.
- 34 Cohen AS, Matharu MS, Goadsby PJ. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or cranial autonomic features (SUNA)—a prospective clinical study of SUNCT and SUNA. Brain 2006; 129: 2746–60.
- 35 Webster JI, Tonelli L, Sternberg EM. Neuroendocrine regulation of immunity. Annu Rev Immunol 2002; 20: 125–63.
- 36 Marteletti P, Giacovazzo M. Putative neuroimmunological mechanisms in cluster headache. An integrated hypothesis. Headache 1996; 36: 312–15.
- 37 Cianchetti C, Zuddas A, Marchei F. High dose intravenous methylprednisolone in cluster headache. J Neurol Neurosurg Psychiatry 1998; 64: 418.
- 38 Antonaci F, Costa A, Candeloro E, Sjaastad O, Nappi G. Single high-dose steroid treatment in episodic cluster headache. Cephalagia 2005; 25: 290–5.
