Sustained response to botulinum toxin in SUNCT syndrome

Introduction: Short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare condition grouped in the category of trigeminal autonomic cephalalgia. The syndrome is characterized by very frequent, unilateral attacks of pain in the ocular and periocular region accompanied by ipsilateral conjunctival injection and lacrimation. The aetiology is unknown, although there have been reports of cases secondary to structural lesions, and treatment is usually ineffective. Patients and Methods: We present the case of a patient diagnosed with SUNCT refractory to pharmacological treatment; duration of the SUNCT was 20 years. OnabotulinumtoxinA was infiltrated at four points around the orbit. Results: The pain showed a dramatic response to onabotulinumtoxinA infiltration. Efficacy has been maintained for 18 months with 3-monthly infiltrations, with no adverse effects. Conclusions: OnabotulinumtoxinA should be added to the limited therapeutic arsenal available for the treatment of refractory cases of SUNCT.