Medullary infarction causing coexistent SUNCT and trigeminal neuralgia

Area of Science:

• Neurology
• Neuroscience
• Headache Medicine

Background:

• Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and its variant with autonomic symptoms (SUNA) are classified under trigeminal autonomic cephalalgias (TACs).
• SUNCT/SUNA share overlapping phenotypes and management strategies with trigeminal neuralgia (TN).
• Cerebral pathologies can trigger TN- or SUNCT-like pain, with neuroimaging suggesting neurovascular conflict in SUNCT, indicating shared pathophysiology with TN.

Observation:

• This report details the first case of coexisting chronic SUNCT and TN-like pain.
• The patient's symptoms were attributed to a haemorrhagic infarct in the dorsolateral medulla.

Findings:

• The dorsolateral medulla's involvement in this case provides novel insights into the pathophysiology of these headache types.
• Perturbation of dorsolateral medullary circuits may be a key factor.

Implications:

• This case supports a unifying nosological hypothesis for SUNCT, SUNA, and TN.
• These conditions could be considered clinical variants of the same underlying disorder.
• Further research into medullary circuits may reveal new therapeutic targets for TACs and TN.