Objective:

To present a case of Ramsey hunt syndrome that presented with SUNCT type of headache 

Background:

Ramsay Hunt syndrome represents reactivation of latent varicella zoster virus in the geniculate ganglion, but sometimes extends to involve other cranial nerves Frequently reported symptoms are unilateral and ipsilateral facial paralysis, and painful vesicles in the auditory canal or on the auricle. 

Design/Methods:

Case report 

Results:

A health 55-year-old female who presented initially with acute-onset pressure-like right ear pain associated with rhinorrhea. On day 4 of symptoms, she reported worsening of symptoms, with change of pain to be excruciating, and sharp limited to 5 seconds or less per attack, innumerable times throughout the day, with associated symptoms of increased lacrimation and ipsilateral conjunctival injection. On examination, she exhibited mild scleral injection of the right eye, reduced sensation to pinprick over the right (V2) and (V1), which appeared worse during attacks, with subtle right lower motor neuron facial weakness. CT head without contrast and CTA were unremarkable. A presumed diagnosis of SUNCT was made, and patient was provided with Lamotrigine and Indomethacin, which improved symptom partially then was discharged. 3 days later she noticed facial weakness and was prescribed a course of oral steroids for 6 days. The following day, she noticed a vesicular rash developing in the pinna of the right ear, for which she was given ten-day course of Valacyclovir then All of her symptoms gradually improved till completely resolved over the next 4 weeks. 

Conclusions:

The patient did meet the criteria for a SUNCT diagnosis according to the (ICHD-3) criteria. Additionally, she symptoms consistent with Ramsey-Hunt syndrome with findings of vesicular rash, facial pain and facial weakness. Our case broadens the understanding of SUNCT, allowing one to consider RHS or herpes zoster as part of the differential for SUNCT.