PT  - JOURNAL ARTICLE
AU  - Giorgio Lambru
AU  - Anker Stubberud
AU  - Khadija Rantell
AU  - Susie Lagrata
AU  - Erling Tronvik
AU  - Manjit Singh Matharu
TI  - Medical treatment of SUNCT and SUNA: a prospective open-label study including single-arm meta-analysis
AID  - 10.1136/jnnp-2020-323999
DP  - 2021 Mar 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 233--241
VI  - 92
IP  - 3
4099  - http://jnnp.bmj.com/content/92/3/233.short
4100  - http://jnnp.bmj.com/content/92/3/233.full
SO  - J Neurol Neurosurg Psychiatry2021 Mar 01; 92
AB  - Introduction 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.Methods 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.Results 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.Conclusions 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.