SUNCT syndrome responsive to gabapentin (Neurontin)

A 48-year-old male suffering with SUNCT (severe unilateral neuralgiform hea dache with conjunctival injection and tearing, rhinorrhea and sub-clinical sweating) presented in 1996 after a 10-year history of multiple failed ther apies. The symptoms included strictly left-sided ocular, as well as facial and temple pain. The pain attacks were burning, sharp, shooting and occurre d 25 times daily, lasting 2 to 3 minutes with tearing and conjunctival inje ction. There was no associated nausea or vomiting, but there was photophobi a. No other autonomic changes were reported and the pain was not triggerabl e. Initially Indocin (indomethacin) was tried without significant benefit. Gabapentin (Neurontin) was then started with improvement at 1800 mg per day . The patient was then lost to follow-up for 3 years, as he moved from the Los Angeles area. He returned in 1999 having stopped the gabapentin after h is prescription ran out in 1996, reporting the pain returned immediately. A gain gabapentin was prescribed and at 900 mg three times daily he has been pain free for 12 months.