Shantel Apeseche1, Stella Chin3, Bridget Leone2
1Child Neurology, Stony Brook University Hospital, 2Stony Brook University Hospital, 3Stony Brook Medicine, Dept of Neurology
Objective:
To report a case of SUNCT treated with Valproic Acid in a Child
Background:
SUNCT (Short acting Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing) is a rare syndrome characterized by attacks of unilateral head pain lasting from seconds to minutes associated with prominent conjunctival injection and tearing. SUNCT primarily affects adult males and lamotrigine is typically used as initial preventative therapy. SUNCT is rare in children and adolescents. Here we present a case of a 9-year-old female admitted to the hospital and successfully treated with valproic acid.
Design/Methods:
Case report
Results:
9-year-old female with severe eczema, nonspecific white matter hyperintensities on prior brain MRI, recently discharged from outside hospital for migraine, presents with severe right-sided headache for two days. On initial presentation, she reports unilateral 10/10 headache with nausea and photophobia treated with ketorolac, diphenhydramine, and metoclopramide with minimal improvement. Shortly after treatment, she experienced another acute attack requiring intranasal versed and was admitted to the hospital. Her physical exam was notable for diffuse eczematous plaques with excoriation. While admitted, she continued to have multiple severe headache attacks and was noted to have right-sided conjunctival injection and tearing with uneven pupils. Repeat brain MRI was unchanged from prior. She was placed on 100% oxygen with mild improvement in her symptoms and was trialed on methylprednisolone 2mg/kg, which was ineffective. Treatment with lamotrigine was considered however, given the severity of her dermatitis, valproic acid 15mg/kg twice daily was initiated, resulting in significant clinical improvement and resolution of headaches at follow-up in 6 weeks.
Conclusions:
Although uncommon in the pediatric population, SUNCT is a headache disorder that should be considered in a young child presenting with headache and unilateral autonomic symptoms. This case presents a unique opportunity to aid in the rare diagnosis and treatment of SUNCT with valproic acid.