The Journal of Headache and Pain

Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

The Journal of Headache and Pain Cover Image

Volume 15 Supplement 1

Abstracts from the 4th European Headache and Migraine Trust International Congress: EHMTIC 2014

Open Access

EHMTI-0272. Microvascular decompression of the trigeminal nerve in the treatment of medically intractable SUNCT and SUNA

  • G Lambru1,
  • S Miller2,
  • N Kitchen3,
  • L Zrinzo3 and
  • M Matharu2
The Journal of Headache and Pain201415(Suppl 1):C34

Published: 18 September 2014




Microvascular decompression (MVD) of the trigeminal nerve has been so far reported to be effective in 12/19 SUNCT and SUNA patients (63 %) with neurovascular compression.


We report the outcome of MVD, using Jannetta procedure, in nine cases of medically intractable chronic SUNCT and SUNA patients.


Nine patients with chronic SUNCT and SUNA with a vascular loop indenting or distorting the trigeminal nerve ipsilaterally to the side of the pain demonstrable on MRI scan were offered MVD of the trigeminal nerve. All the patients failed to respond or tolerate adequate dosages of: lamotrigine, topiramate, oxcarbazepine, carbamazepine, duloxetine, pregabalin or gabapentin and greater occipital nerve blocks. Intravenous lidocaine improved the pain only during infusion in some of them.


Seven SUNCT and two SUNA patients underwent MVD of the trigeminal nerve. They all had multiple daily severe headache attacks at baseline. At a median follow-up of 15 months (range: 8-30 months) after the operation, four patients became and remained pain free, one patient each had 90%, 70% and 50% improvement, respectively. The patient who improved by 50% was rendered pain free on preventive treatments. Two patients became pain free for 12 months, before pain returned. One patient suffered a CSF leak after the procedure.


MVD of the trigeminal nerve was effective in 7/9 SUNCT/SUNA patients (78%). Although longer follow-up is needed to establish the long term outcome of this procedure, these preliminary data support the role of MVD in the surgical management of SUNCT and SUNA.

No conflict of interest.

Authors’ Affiliations

Headache Group, UCL Institute of Neurology, London, UK
Headache Group, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK


© Lambru et al; licensee Springer. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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