Pathophysiology
Functional MRI studies suggest hypothalamic activation as a potential mechanism for SUNCT syndrome, which could also apply to cases secondary to intracranial lesions like meningiomas [PMID:20428918].
Differential Diagnosis
This case report highlights that meningiomas, previously unreported in SUNCT syndrome, can be a causative factor, expanding the differential diagnosis for SUNCT syndrome [PMID:20428918].
Management
This retrospective study compared lacosamide, gabapentin, and baclofen in patients with secondary trigeminal neuralgia, highlighting their efficacy as alternatives when first-line treatments such as carbamazepine are ineffective or poorly tolerated [PMID:40341553].
Previous meta-analyses, including those referenced in this study, indicate that gabapentin demonstrates similar efficacy to carbamazepine, though direct comparisons of adverse effects between these drugs are needed [PMID:40341553].
An 81-year-old woman with secondary SUNCT syndrome due to a meningioma experienced full responsiveness to gabapentin treatment [PMID:20428918].
Complications
The study underscores that adverse effects are common with first-line medications such as carbamazepine, resulting in treatment discontinuation in nearly one-third of patients, necessitating exploration of second-line options [PMID:40341553].
References
1 Muñoz-Vendrell A, Valín-Villanueva P, Tena-Cucala R, Campoy S, Martínez-Yélamos S, Huerta-Villanueva M. Second-line pharmacological treatment strategies for trigeminal neuralgia: A retrospective comparison of lacosamide, gabapentin and baclofen. Headache 2025. link 2 Kutschenko A, Liebetanz D. Meningioma causing gabapentin-responsive secondary SUNCT syndrome. The journal of headache and pain 2010. link
2 papers cited of 3 indexed.