Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK.
Department of Neuromedicine and Movement Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
J Neurol Neurosurg Psychiatry. 2021 Mar;92(3):233-241. doi: 10.1136/jnnp-2020-323999. Epub 2020 Dec 24.
The management 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) remains challenging in view of the paucity of data and evidence-based treatment recommendations are missing.
In this single-centre, non-randomised, prospective open-label study, we evaluated and compared the efficacy of oral and parenteral treatments for SUNCT and SUNA in a real-world setting. Additionally, single-arm meta-analyses of the available reports of SUNCT and SUNA treatments were conducted.
The study cohort comprised 161 patients. Most patients responded to lamotrigine (56%), followed by oxcarbazepine (46%), duloxetine (30%), carbamazepine (26%), topiramate (25%), pregabalin and gabapentin (10%). Mexiletine and lacosamide were effective in a meaningful proportion of patients but poorly tolerated. Intravenous lidocaine given for 7-10 days led to improvement in 90% of patients, whereas only 27% of patients responded to a greater occipital nerve block. No statistically significant differences in responders were observed between SUNCT and SUNA. In the meta-analysis of the pooled data, topiramate was found to be significantly more effective in SUNCT than SUNA patients. However, a higher proportion of SUNA than SUNCT was considered refractory to medications at the time of the topiramate trial, possibly explaining this isolated difference.
We propose a treatment algorithm for SUNCT and SUNA for clinical practice. The response to sodium channel blockers indicates a therapeutic overlap with trigeminal neuralgia, suggesting that sodium channels dysfunction may be a key pathophysiological hallmark in these disorders. Furthermore, the therapeutic similarities between SUNCT and SUNA further support the hypothesis that these conditions are variants of the same disorder.
鉴于数据有限，且缺乏基于证据的治疗建议，短发性单侧头痛发作伴结膜充血和流泪（SUNCT）和短发性单侧头痛发作伴颅自主神经症状（SUNA）的管理仍然具有挑战性。
在这项单中心、非随机、前瞻性、开放标签研究中，我们在真实环境中评估和比较了口服和静脉治疗 SUNCT 和 SUNA 的疗效。此外，对现有的 SUNCT 和 SUNA 治疗报告进行了单臂荟萃分析。
研究队列包括 161 名患者。大多数患者对拉莫三嗪（56%）有反应，其次是奥卡西平（46%）、度洛西汀（30%）、卡马西平（26%）、托吡酯（25%）、普瑞巴林和加巴喷丁（10%）。美西律和拉科酰胺对一部分患者有效，但耐受性差。静脉给予利多卡因 7-10 天可使 90%的患者症状改善，而大枕神经阻滞仅使 27%的患者有反应。SUNCT 和 SUNA 患者之间的应答者无统计学差异。在汇总数据的荟萃分析中，发现托吡酯治疗 SUNCT 比 SUNA 患者更有效。然而，在托吡酯试验时，SUNA 比 SUNCT 有更高比例的患者被认为对药物有抗药性，这可能解释了这一孤立的差异。
我们提出了一个用于 SUNCT 和 SUNA 的治疗算法，用于临床实践。钠离子通道阻滞剂的反应表明与三叉神经痛的治疗有重叠，这表明钠离子通道功能障碍可能是这些疾病的关键病理生理学特征。此外，SUNCT 和 SUNA 之间的治疗相似性进一步支持了这些情况是同一疾病的变异的假说。
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