SUNCT: Bilateral hypothalamic activation during headache attacks and resolving of symptoms after trigeminal decompression

Till Sprenger, Michael Valet, Stefan Platzer, Volker Pfaffenrath, Ulrich Steude, Thomas R. Tolle

Research output: Contribution to journalArticlepeer-review

126 Scopus citations

Abstract

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is a primary head-pain syndrome, which is often refractory to any medical treatment. Concerning the pathophysiology of SUNCT, hypothalamic involvement ipsilaterally to the pain has been suggested based on the clinical features and one functional imaging case report. Here we now report a new case with SUNCT and the concomitant cerebral activation pattern (fMRI) during the pain attacks. In addition to an activation of several brain structures known to be generally involved in pain processing, bilateral hypothalamic activation occurred during the pain attacks, arguing for a central origin of the headache. Interestingly, this patient became completely pain free after surgical decompression of the ipsilateral trigeminal nerve. We hypothesize that in this case with a central predisposition for trigeminal autonomic cephalgias, a peripheral trigger with ectopic excitation might have contributed to the clinical picture of SUNCT.

Original languageEnglish
Pages (from-to)422-426
Number of pages5
JournalPain
Volume113
Issue number3
DOIs
StatePublished - Feb 2005
Externally publishedYes

Keywords

  • Hypothalamus
  • Jannetta procedure
  • SUNCT
  • Trigeminal autonomic cephalgia
  • fMRI

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