Complete alleviation of treatment refractory primary SUNCT syndrome with clomiphene citrate (a medicinal deep brain hypothalamic modulator)

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Results: SUNCT is a primary headache disorder marked by frequent attacks of one-sided headache with cranial autonomic associated symptoms. When SUNCT is deemed medicinally treatment refractory, it can cause tremendous patient-related disability. Surgical treatment options are available including hypothalamic deep brain stimulation, occipital nerve stimulator placement or arterial decompression surgery, but these procedures carry significant morbidity. A patient presented with a 10 month complaint of multiple, daily short-lasting, right-sided headaches each lasting from 60 to 120 seconds in duration and occurring from 100 to 200 times per day. The head pain was associated with ipsilateral eyelid ptosis and conjunctival injection. The patient was diagnosed with SUNCT but was unresponsive to multiple recognized medicinal treatments. He had complete alleviation of his attacks with clomiphene citrate, a synthetic, nonsteroidal, ovulatory stimulant that directly binds to hypothalamic estrogen receptors. The clomiphene was tolerated without any adverse events. A putative mechanism of action for clomiphene in the prevention of SUNCT will be presented.

Conclusion: Clomiphene citrate is a unique treatment for SUNCT and appears to be very safe and effective.

Objective: To report the first ever case of primary short-lasting unilateral neuralgiform headache attacks (SUNCT) syndrome completely responsive to clomiphene citrate.

Methods: Case report.

Original languageEnglish (US)
Pages (from-to)1021-1024
Number of pages4
JournalCephalalgia
Volume34
Issue number12
DOIs
StatePublished - Oct 27 2014

Keywords

  • Clomiphene citrate
  • SUNCT
  • cluster headache
  • estrogen
  • hypocretin
  • hypothalamus
  • orexin

ASJC Scopus subject areas

  • Clinical Neurology

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