Osman Özgür YALIN, Derya ULUDÜZ, Aynur ÖZGE

Gebelikte konjunktival injeksiyon ve göz yaşarması ile birlikte kısa–süreli unilateral nevraljifrm başağrısı ataklarında (SUNCT) periferal sinir blokajı tedavisi

Konjunktival injeksiyon ve göz yaşarması ile birlikte kısa-süreli unilateral nevraljifrm başağrısı atakları (SUNCT), trigeminal otonomik başağrıları içerisinde sınıflandırılan nadir gözlenen bir primer başağrısı bozukluğudur. SUNCT genellikle tedaviye dirençli bir sendrom olarak kabul edilmesine rağmen son yıllarda antiepileptik ilaçlar ile anlamlı düzelme bildirilmektedir. Hastalığın gebelikteki seyri ve tedavisi ile ilgili literatürde bilgi yoktur. Bu çalışmada 30 haftalık gebelik sırasında SUNCT atağı yaşayan, infra- ve supraorbital sinir blokajı ile başarılı bir şekilde tedavi edilen bir olgu sunulmaktadır. Aslında gebelik döneminde lamotrijin kısmen güvenli olarak kullanılmaktadır, fakat periferal sinir blokajı uygulanması pratik, güvenli ve etkin bir alternatif tedavi seçeneğidir. Bu olgu literatürde gebelik döneminde infra- ve supraorbital sinir blokajı ile başarılı bir şekilde tedavi edilen ilk SUNCT hastasıdır

Peripheral nerve blocks for the treatment of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) during pregnancy

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare, primary headache syndrome, which is classified as a subtype of trigeminal autonomic cephalalgias. Although SUNCT is usually refractory to treatment, several antiepileptic drugs have recently shown promising results for its treatment. However, there is a lack of evidence regarding the course of SUNCT during pregnancy and the available treatment options. Here, we present a 30-week pregnant female with SUNCT who was successfully treated with infra- and supraorbital nerve blocks. Headache attacks completely diminished after the injection, and recurrence was not observed. Although lamotrigine may be relatively safe in pregnant patients with SUNCT attacks, peripheral nerve block may be a feasible technique and can be considered as a safe and effective treatment option. This is the first SUNCT case in the literature that was successfully treated with infra- and supraorbital nerve blocks during pregnancy

PDF

___

1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013;33(9):629–808.
2. Cohen AS, Matharu MS, Goadsby PJ. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or cranial autonomic features (SUNA)-a prospective clinical study of SUNCT and SUNA. Brain 2006;129(Pt 10):2746–60.
3. Pareja JA, Caminero AB, Sjaastad O. SUNCT Syndrome: diagnosis and treatment. CNS Drugs 2002;16:373–83.
4. Lambru G, Matharu MS. SUNCT and SUNA: medical and surgical treatments. Neurol Sci 2013 May;34 Suppl 1:S75-81.
5. Pomeroy JL, Nahas SJ. SUNCT/SUNA: A Review. Curr Pain Headache Rep 2015;19(8):38.
6. Lyons MK, Dodick DW, Evidente VG. Responsiveness of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing to hypothalamic deep brain stimulation. J Neurosurg 2009;110(2):279–81.
7. Bartsch T, Falk D, Knudsen K, Reese R, Raethjen J, Mehdorn HM, et al. Deep brain stimulation of the posterior hypothalamic area in intractable short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). Cephalalgia 2011;31(13):1405–8.
8. Irimia P, González-Redondo R, Domínguez PD, Díez-Valle R, Martínez-Vila E. Microvascular decompression may be effective for refractory SUNCT regardless of symptom duration. Cephalalgia 2010;30(5):626–30.
9. Choi HJ, Choi SK, Lee SH, Lim YJ. Whiplash injury-induced atypical short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome treated by greater occipital nerve block. Clin J Pain 2012;28(4):342–3.
10. Porta-Etessam J, Cuadrado ML, Galán L, Sampedro A, Valencia C. Temporal response to bupivacaine bilateral great occipital block in a patient with SUNCT syndrome. J Headache Pain 2010;11(2):179.
11. Cohen AS, Matharu MS, Goadsby PJ. Trigeminal autonomic cephalalgias: current and future treatments. Headache 2007;47(6):969–80.
12. McLauchlan D, Robertson M, Drage NP. Sunct: A novel therapeutic approach. J Neurol Neurosurg Psychiatry 2012;83(2):6.