Short-Lasting Unilateral Neuralgiform Headache With Conjunctival Injection and Tearing (SUNCT) Improves With Bilateral Ventral Tegmental Area Deep Brain Stimulation.

Document Type

Article

Abstract

BACKGROUND: Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is a severe headache disorder characterized by clustered episodes of extreme pain. Refractory to most interventions, ipsilateral unilateral ventral tegmental area (VTA) deep brain stimulation (DBS) has been previously reported to be efficacious in 14 cases.

METHODS AND RESULTS: Herein, we report the first case of an individual with medically refractory SUNCT who underwent bilateral VTA DBS. The patient experienced better improvement of his headaches with bilateral stimulation compared to unilateral stimulation. He also had a return of severe headaches within a few hours after his stimulator was switched off during sleep, with rebound worsening of his headaches over several days. The main side effects were double vision and difficulty focusing while reading, which were observed primarily with unipolar stimulation that required high voltages, high frequencies, and multiple negative contacts to control the headaches. The side effects were minimized with bipolar and interleaving stimulation with comparable control of his headaches.

CONCLUSION: Bilateral VTA DBS may be effective in alleviating medical refractory SUNCT.

Medical Subject Headings

Deep Brain Stimulation; Humans; Male; Middle Aged; SUNCT Syndrome; Ventral Tegmental Area

Publication Date

11-1-2020

Publication Title

Headache

ISSN

1526-4610

Volume

60

Issue

10

First Page

2548

Last Page

2554

PubMed ID

33038268

Digital Object Identifier (DOI)

10.1111/head.13989

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