A patient with SUNCT syndrome responsive to sodium valproate (original) (raw)

2002, The Journal of Headache and Pain

SUNCT syndrome (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) was first described in 1989 [1]. It is a rare and painful syndrome characterized by strictly unilateral, short-lasting (5-120 seconds) attacks associated with signs of local involvement of the autonomic system. The most important (so to be part of the acronym SUNCT) are conjunctival injection and tearing [2, 3]. Other signs are often, but not always, described: nasal stiffness, rhinorrhea, narrowing of the palpebral fissure, eyelid edema and miosis. These signs and symptoms are strictly ipsilateral to the pain. The pathophysiology of this headache form is still unknown. Goadsby and Lipton [4] proposed classifying SUNCT syndrome as a trigeminal autonomic cephalalgia (TAC), together with cluster headache (CH), chronic paroxysmal migraine (CPH), trigeminal neuralgia (TN) and others. The treatment of SUNCT syndrome has been disappointing until 1999, when D'Andrea et al. [5] reported a therapeutic effect of lamotrigine. Based on the present case report of an elderly man with SUNCT, sodium valproate may also be an effective treatment for this debilitating headache. Case report A 74-year-old man reported experiencing, since the age of 70 years, pain attacks involving first the forehead and the periorbital region, and then spreading to the nose and upper lip. These areas were involved strictly in the left side. The attacks had a high intensity and an abrupt onset, lasted 10-30 seconds and occurred almost every day between 6:00 and 8:00 AM or, more rarely, between 2:00 and 4:00 PM.