Open Access

Temporal response to bupivacaine bilateral great occipital block in a patient with SUNCT syndrome

  • Jesús Porta-Etessam1Email author,
  • Maria L. Cuadrado1,
  • Lucía Galán2,
  • Arturo Sampedro2 and
  • Cristina Valencia2
The Journal of Headache and Pain201011:204

https://doi.org/10.1007/s10194-010-0204-5

Received: 14 February 2010

Accepted: 17 February 2010

Published: 16 March 2010

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome is an infrequent form of unilateral headache accompanied by cranial autonomic features [1]. The pain is severe, and the titrations of some of the drugs have to be slow to prevent side effects [2, 3]. We present a case of a patient with SUNCT syndrome who showed a temporal improvement of pain with bupivacaine greater occipital nerve (GON) block.

A 82-year-old woman was admitted because of recent onset of facial pain. Intense attacks of periocular left pain, lasting for 2 min, had started 3 days previously. She also experienced conjunctival injection and lacrimation during the attacks. She suffered from 10 to 20 attacks per day. The neurological examination was absolutely normal, except that touching the left forehead triggered the pain without any refractory period. In the emergency room, with the suspicion of trigeminal neuralgia, she was prescribed carbamazepine 600 mg daily for a week, phenytoin 300 mg daily for a week and tramadol 100 mg for 4 days, without any improvement. After a headache unit evaluation the diagnosis of SUNCT was made and we put the patient on lamotrigine and gabapentin with slow titration. Because the patient was suffering from intense pain we decided to prove a bupivacaine GON block; she was asymptomatic for 48 h. After 2 weeks she started with gabapentin 1,800 mg and lamotrigine 75 mg daily. The pain attacks improved and in one more week she became asymptomatic.

The response of SUNCT to intravenous lidocaine has been described previously [4]. Intravenous lidocaine perfusion carries risks, especially in the elderly [4]. GON block has been used in several primary headaches, such as migraine, cluster headache and hemicrania continua. Some studies show that GON block could change trigeminal activity [5]. GON block is a safe therapy and could be an option for alleviation of SUNCT pain during oral drugs titration.

Declarations

Conflict of interest

None.

Authors’ Affiliations

(1)
Headache Unit, Neurology Department, Hospital Universitario Clínico San Carlos
(2)
Neurology Department, Hospital Universitario Clínico San Carlos

References

  1. Pareja JA, Sjaastad O (1997) SUNCT syndrome. A clinical review. Headache 37:195–202 10.1046/j.1526-4610.1997.3704195.x, 1:STN:280:DyaK2s3psV2nsg%3D%3D, 9150613View ArticlePubMedGoogle Scholar
  2. Porta-Etessam J, Martinez-Salio A, Berbel A, Benito-Leon J (2002) Gabapentin (neuronetin) in the treatment of SUNCT syndrome. Cephalalgia 22(3):249 10.1046/j.1468-2982.2002.00375.x, 1:STN:280:DC%2BD38zgsF2jtQ%3D%3D, 12047467View ArticlePubMedGoogle Scholar
  3. D’Andrea G, Granella F, Ghiotto N, Nappi G (2001) Lamotrigine in the treatment of SUNCT syndrome. Neurology 57(9):1723–1725 11706123View ArticlePubMedGoogle Scholar
  4. Arroyo AM, Durán XR, Beldarrain MG, Pinedo A, García-Moncó JC (2010) Response to intravenous lidocaine in a patient with SUNCT syndrome. Cephalalgia 30:110–112PubMedGoogle Scholar
  5. Busch V, Jakob W, Juergens T, Schulte-Mattler W, Kaube H, May A (2006) Functional connectivity between trigeminal and occipital nerves revealed by occipital nerve blockade and nociceptive blink reflexes. Cephalalgia 26(1):50–55 10.1111/j.1468-2982.2005.00992.x, 1:STN:280:DC%2BD28%2FhtVCmtQ%3D%3D, 16396666View ArticlePubMedGoogle Scholar

Copyright

© Springer-Verlag 2010