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An Unusual Case of Episodic SUNCT Responding to High Doses of Topiramate
Author(s) -
Khalil Modar,
Maniyar Farooq,
Ahmed Fayyaz
Publication year - 2014
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.12445
Subject(s) - topiramate , medicine , lamotrigine , cluster headache , headaches , anesthesia , dermatology , epilepsy , migraine , surgery , psychiatry
T rigeminal autonomic cephalalgias ( TAC ) are rare. Cluster headaches comprise the majority, with short‐lasting unilateral neuralgiform headache with conjunctival injection and tearing ( SUNCT ) being the rarest and shortest in duration. The majority of SUNCT are primary with a few cases occurring secondary to posterior fossa or pituitary lesions. Although activities like exercise or blowing of the nose can trigger SUNCT , onset during orgasm has not been described. Short‐lasting aura has been described in TACs including SUNCT , but persistence of focal symptoms and signs without an underlying structural lesion have not been described. Lastly, treatment of SUNCT is difficult, with lamotrigine being the most common effective reported. We report a case of episodic SUNCT with symptoms suggestive of brainstem stroke that completely resolved spontaneously for which no underlying structural cause was found. The onset of first attack occurred during orgasm, and the patient responded to a high dose of topiramate.