SUNCT syndrome: A possible bilateral case responding to topiramate

The short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome was first described in 1978 and is characterized by short-lasting, unilateral, usually retro-orbital headache attacks and concomitant autonomic symptoms, mainly in the form of conjunctival injection and tearing.1–3 The attacks occur between 3 and 200 times per day and last between 5 and 240 seconds.2 The pain is neuralgiform, so it can be difficult to distinguish from trigeminal neuralgia. Over the last 5 years, an otherwise healthy 23-year-old man had 20 to 30 headache attacks per day. He reported the mean duration of the attacks as 1 minute, with some shorter than 30 seconds and none longer than 2 minutes. The location of his headache was always bilateral, retro-orbital, and temporal. It occasionally radiated …