Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses
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Headache (J Couch, Section Editor)
Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses Anker Stubberud, MD1,2 Erling Tronvik, MD, PhD2,3 Manjit Matharu, MBChB, PhD1,* Address *,1 Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK Email: [email protected] 2 Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway 3 Department of Neurology, St. Olavs Hospital, Trondheim, Norway
* The Author(s) 2020
This article is part of topical Collection on Headache Keywords Paroxysmal hemicrania I Hemicrania continua I Short-lasting unilateral neuralgiform headache attacks I SUNCT I Trigeminal autonomic cephalalgia
Abstract Purpose of Review This review presents a critical appraisal of the treatment strategies for short-lasting unilateral neuralgiform headache attacks (SUNHA), paroxysmal hemicrania (PH), and hemicrania continua (HC). We assess the available, though sparse, evidence on both medical and surgical treatments. In addition, we present estimated pooled analyses of the most common treatments and emphasize recent promising findings. Recent Findings The majority of literature available on the treatment of these rare trigeminal autonomic cephalalgias are small open-label observational studies and case reports. Pooled analyses reveal that lamotrigine for SUNHA and indomethacin for PH and HC are the preventative treatments of choice. Second-line choices include topiramate, gabapentin, and carbamazepine for SUNHA; verapamil for PH; and cyclooxygenase-2 inhibitors and gabapentin for HC. Parenteral lidocaine is highly effective as a transitional treatment for SUNHA. Novel therapeutic strategies such as non-invasive neurostimulation, targeted nerve and ganglion blockades, and invasive neurostimulation, including
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implanted occipital nerve stimulators and deep brain stimulation, appears to be promising options. Summary At present, lamotrigine as a prophylactic and parenteral lidocaine as transitional treatment remain the therapies of choice for SUNHA. While, by definition, both PH and CH respond exquisitely to indomethacin, evidence for other prophylactics is less convincing. Evidence for the novel emerging therapies is limited, though promising.
Introduction Short-lasting unilateral neuralgiform headache attacks (SUNHA), paroxysmal hemicrania (PH), and hemicrania continua (HC) are all classified as trigeminal autonomic cephalalgias (TACs) by the International Classification of Headache Disorders [1]. TACs are mainly characterized by unilateral trigeminal distribution pain that occurs in association with ipsilateral cranial autonomic features [2]. SUNHA and PH are characterized by short-lasting intense headache attacks, with their main difference being in attack duration and frequency as well as the response to therapy. In con
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