Neurology India
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Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA) are rare and disabling primary headache disorders that are subtypes of Short-lasting unilateral neuralgiform headache attacks (SUNHA). ⋯ Of a potential 1103 articles, seven case series describing clinical characteristics of SUNCT/SUNA patients were identified for this review. For symptomatic/secondary SUNCT/SUNA, 53 individual case reports, and one case series were reviewed. One placebo-controlled trial and 11 open-label case series that evaluated various medical and surgical treatments in SUNCT/SUNA were also reviewed. Available literature suggests that SUNCT and SUNA are subtypes of the same disorder characterized by severe side locked short duration headache with ipsilateral prominent cranial autonomic symptoms and signs. Pathophysiology may involve both peripheral and central mechanisms. Lamotrigine is the most effective preventive therapy while intravenous lidocaine is the most efficacious drug as transitional therapy for severe disabling attacks. Surgical options including microvascular decompression in those having neurovascular conflict, occipital nerve stimulation, and hypothalamic deep brain stimulation can be alternative treatment options for medically refractory patients.
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Disability from migraine has a profound impact on the world's economy. Research has been ongoing to identify biomarkers to aid in diagnosis and treatment. ⋯ Although there are several proposed biomarkers for migraine, continued research is needed to substantiate their role in clinical practice.
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Medications targeting the calcitonin gene-related peptide (CGRP) pathway are exciting and novel therapeutic options in the treatment of migraine. ⋯ Increasing use of these medications will certainly revolutionize the treatment and outlook for patients with migraine all over the world.
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Patients with aneurysmal subarachnoid hemorrhage (SAH) have a low quality of life (QOL) despite diagnostic and therapeutic advancements. Less than half of the survivors can return to their previous jobs and have difficulty in being a functional part of society. Our study aimed to understand the overall outcome and QOL of these patients and to identify the predictive factors determining the same. ⋯ Though fewer of the patients had a severe disability, a majority of them had deterioration in QOL.