Dados do Trabalho

Título

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) responsive to intranasal lidocaine and nerve blockage: a case report

RESUMO

Case Presentation:
A 75-year-old male patient went to the emergency department due an intense recurrent and refractory daily headache that initiated in the previous two months, was described as a stabbing, was exclusively right-sided and had maximal duration of 10 seconds, with recurrence at least every 10 minutes and no refractory period. It was mostly perceived in the ophthalmic nerve (V1), with ipsilateral allodynia and autonomic symptoms, such as conjunctival injection, lacrimation and ptosis. The pain was unresponsive to acetaminophen and non-steroidal anti-inflammatory drugs. In his neurological examination, we reproduced the headache’s episodes when the right V1 region was lightly touched. Based on the elevated frequency, short duration of attacks and presence of ipsilateral autonomic features, SUNCT diagnosis was made. A treatment regimen of trochlear, supra-orbital, major and minor occipital nerve anesthetic blockades using 2% lidocaine without vasoconstrictor was made in association with a preventive treatment with Lamotrigine 100mg twice a day. Also, he was instructed to do a sphenopalatine ganglion block by slowly dripping 2 mL of intranasal 2% lidocaine in his right nose when symptoms recurred. The patient had no pain for at least six months of these treatments, not needing to use intranasal lidocaine anymore.

Discussion:
Trigeminal autonomic cephalalgias comprehend a myriad of headaches which include the short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) and with conjunctival injection and tearing (SUNCT). Intravenous lidocaine has been consistently described as the treatment of choice for acute episodes, but there is a risk of severe cardiac side effects (arrhythmias), mainly for older adults. Therefore, they can benefit from alternate, less harming and secure treatment options such as intranasal lidocaine drip and nerve blockades in the area corresponding to the pain, like in this case.

Final Comments:
Our SUNCT patient had a very satisfactory response of headache after treatment with the simple and relatively safe procedures previously described, which presented efficient acute pain control within a large follow-up period. Similar acute treatments were reported for SUNCT/SUNA with satisfactory results, but data on this topic are still scarce in the literature, being based mostly on case reports and small studies, so further studies are mandatory in order to corroborate the findings of this case report.

Palavras Chave

SUNCT, nerve blockage, lidocaine, lamotrigine, headache