SUNCT (Short-lasting unilateral neuralgiform headache attack with conjunctival injection and tearing) associated with pituitary lesion.

SUNCT (short-lasting unilateral neuralgiform headache attack with conjunctival injection and tearing) syndrome was first defined by Sjaastad et al. in 1978. Since then, several studies on this topic have been published. The International Classification of Headache Disorders currently places it in the trigeminal autonomic cephalalgias subgroup. Although it is considered a primary headache in most cases, other cases are secondary to structural abnormalities in the posterior fossa, and especially in the hypophyseal region. More controversial is whether or not pharmacological agents may trigger this entity. For example, dopaminergic agents may exert a bidirectional influence. We describe one case of SUNCT syndrome secondary to consumption of ergoline dopamine agonist in a patient with hyperprolactinemia due to pituitary microadenoma. Our patient was a 24-year-old man with a diagnosis of hyperprolactinemia secondary to right-sided pituitary microprolactinoma without cavernous sinus invasion. The patient was in treatment with cabergoline. After treatment onset, he experienced intense and pulsatile headache episodes. Pain was located in the right periorbital region and accompanied by conjunctival injection, tearing, and ipsilateral rhinorrhoea. Episodes lasted no more than 3 minutes, but they progressively grew more frequent until the patient was experiencing episodes every 30 minutes daily. Headache met criteria for SUNCT syndrome. Doctors suspended treatment with cabergoline and began lamotrigine dosed at 50 mg/12 h. A new MRI revealed a pituitary microadenoma with no changes with respect to a previous MRI (Figs. 1 and 2). Fifteen days after changing treatment, the patient showed clear signs of improvement; by 3 months, he had fewer than 5 episodes per month. Since prolactin levels remained high, doctors began treatment with quinagolide (non-ergoline dopaminergic agent); this reverted prolactin levels to normal but did not exacerbate the headaches. The literature describes patients with SUNCT syndrome with pituitary micro or macroadenomas, both functional and non-functional. Although the pathophysiological