Chapter 015. Headache (Part 18) pot

Headache Part 18 Secondary Symptomatic SUNCT SUNCT can be seen with posterior fossa or pituitary lesions.. All patients with SUNCT/SUNA should be evaluated with pituitary function test

Chapter 015 Headache

(Part 18)

Secondary (Symptomatic) SUNCT

SUNCT can be seen with posterior fossa or pituitary lesions All patients with SUNCT/SUNA should be evaluated with pituitary function tests and a brain MRI with pituitary views

SUNCT/SUNA: Treatment

Abortive Therapy

Therapy of acute attacks is not a useful concept in SUNCT/SUNA since the attacks are of such short duration However, intravenous lidocaine, which arrests the symptoms, can be used in hospitalized patients

Preventive Therapy

Long-term prevention to minimize disability and hospitalization is the goal

of treatment The most effective treatment for prevention is lamotrigine, 200–400 mg/d Topiramate and gabapentin may also be effective Carbamazepine, 400–500 mg/d, has been reported by patients to offer modest benefit

Surgical approaches such as microvascular decompression or destructive trigeminal procedures are seldom useful and often produce long-term complications Greater occipital nerve injection has produced limited benefit in some patients

Mixed success with occipital nerve stimulation has been observed Complete control with deep-brain stimulation of the posterior hypothalamic region was reported in a single patient For intractable cases, short-term prevention with intravenous lidocaine can be effective

Chronic Daily Headache

The broad diagnosis of chronic daily headache (CDH) can be applied when

a patient experiences headache on 15 days or more per month CDH is not a single entity; it encompasses a number of different headache syndromes, including chronic TTH as well as headache secondary to trauma, inflammation, infection, medication overuse, and other causes (Table 15-10) Population-based estimates

suggest that about 4% of adults have daily or near-daily headache Daily headache may be primary or secondary, an important consideration in guiding management

of this complaint

Table 15-10 Classification of Chronic Daily Headache

>4 h Daily <4 h Daily Secondary

Chronic migrainea

Chronic cluster headacheb

Posttraumatic

Chronic tension- Chronic paroxysmal Inflammatory, such

type headachea

Hemicrania

continuaa

infection

persistent headachea

Hypnic headache Medication-overuse

headachea

a

May be complicated by analgesic overuse

b

Some patients may have headache > 4 h per day

Note: SUNCT, short-lasting unilateral neuralgiform headache attacks with

conjunctival injection and tearing; SUNA, short-lasting unilateral neuralgiform

headache attacks with cranial autonomic symptoms