Neurology Medical News about SUNCT Syndrome Prolactinoma Lamotrigine

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Bilateral SUNCT-like headache in a patient with prolactinoma responsive to lamotrigine
The Journal of Headache and Pain, 09/21/09

Zidverc–Trajkovic J et al. – Short–lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome is a rare trigeminal autonomic cephalalgia. The cases of SUNCT with attacks that affected both sides simultaneously have only rarely been reported and some of them had underlying pathology. The authors have reported a case of bilateral SUNCT–like headache secondary to a prolactinoma and responsive to lamotrigine treatment.

Exclusive Author Commentary
Jasna Zidverc-Trajkovic, 09/23/09

A few implications from this case report could be useful for clinical practice. Despite the fact that attack’s features fulfilled the criteria for SUNCT, the headache of the presented patient was atypical because of bilateral presentation which is more frequently observed in symptomatic cases. The effectiveness of lamotrigine in our patient with symptomatic headache underlines that good response to therapy does not exclude the need for extensive diagnostic work-up in order to exclude the underlying pathology. Frequent association of pituitary tumors and SUNCT-like headache, even without clinical manifestation of endocrine dysfunction suggests the need for cranial MRI and screening of basal hormone levels, especially prolactine and growth-hormone. Causal therapy with bromocriptine decreased serum prolactine levels to normal values after only two months, while the headaches resolved after six months of therapy, requiring simultaneous symptomatic treatment with lamotrigine.

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