SUNCT syndrome: The materialization of a headache syndrome

Shortlasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome is a rare headache, described by our group in 1989. This overview presents our early studies of SUNCT pathogenesis. Due to the conspicuous ictal, ocular phenomena, ie, conjunctival injection and tearing, our studies started out with ocular parameters: intraocular pressure and corneal indentation pulse amplitudes, both of which showed clear ictal increments, symptomatic side. Beat-to-beat, noninvasive blood pressure measurements during attack showed instant, systolic blood pressure rise and corresponding pulse rate decrease. Carotid body, the principal peripheral chemoreceptor, seemed to function normally. The middle cerebral artery was dilated during attacks, particularly on the symptomatic side. Finally, some viewpoints are added regarding terminology. SUNCT is a workable and accepted term. There does not seem to be any need for another, fictitious term to describe the same clinical picture

Epilepsy prevalence by individual interview in a Norwegian community

SummaryIncomplete case finding is a problem in epidemiological studies of epilepsy. We tried to optimize case ascertainment by combining information from individual interviews and medical records. During 2 years, 1838 inhabitants of Vågå, Norway, aged 18–65 (88.6% of the target population) were interviewed as part of an epidemiological study of headache. Individuals with learning disability, mental disorders and dementia were excluded. One question concerning epilepsy was presented to 1793 consecutive cases (mean age 35, males 49%): “Have you ever had convulsions, epileptic fits or other epileptic symptoms?” The medical records of the 133 subjects who acknowledged this possibility were reviewed, and telephone interviews were performed when needed. A diagnosis of epilepsy had been made in 41 subjects. Twenty-one were treated with antiepileptic drugs, of whom 12 had had seizures within the last 5 years. By this unique method of case ascertainment, the prevalence of epilepsy in adults (cases under treatment) was 1.2%, and of active cases 0.7%, despite the fact that high-risk groups for epilepsy, such as elderly people and individuals with cognitive deficits, were excluded. Although these findings were derived from a small population in a circumscribed rural area, they suggest that the true prevalence of epilepsy may be higher than reflected in many previous studies

Hemicrania continua: major shortcomings in the new classification

Hemicrania continua ( HC) was described and coined by Sjaastad and Spierings in 1984. Later cases, carrying this appellation should, grossly, conform to this original description. The proposed classification criteria (ICHD, 3rd edition beta version) for HC has major shortcomings, and ordinary HC cases do not fulfill the proposed criteria. Relatively rare symptoms and signs are e.g. made obligatory (point C 1). And the recommended dosage of indomethacin- both test and long-term dosages-is unallowably high. In this way, bogus HC cases are systematically created. This irrational diagnostic system is in urgent need of a major revision