[P3-185] Good Response to Lamotrigine in a Child with Primary Headache Disorder Resembling SUNCT Syndrome
[Introduction] Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a form of trigeminal autonomic cephalgia affecting predominantly adult, with only a few cases reported in children. The symptoms are generally refractory to the treatment used in other primary headache disorders. Some case reports and short series have suggested lamotrigine to be a promising treatment option. [Case Report] An eleven year old girl presented with nine-month history of recurrent right eye conjunctival injection associated with severe ipsilateral supra-orbital throbbing pain. The pain lasted for a few minutes, with numerous episodes within a day that could continue up to a week, followed by two to three weeks of symptom-free interval. She was initially evaluated by ophthalmologists, with no significant eye pathology detected. She had no other neurological deficit. Brain MRI was normal. The attacks were only partially alleviated by analgesics, and showed no response to flunarizine. Her symptoms improved with short course of prednisolone, but recurred soon after it was discontinued. Lamortrigine was commenced later, and she had no further headache although she still experienced conjunctival injection occasionally. [Conclusion] This case suggests that the role of lamotrigine as a potential first-line prophylactic treatment in SUNCT syndrome may be extended to include pediatric population. Early recognition and diagnosis of this rare but disabling disorder in children will prevent delay in commencing the potentially effective treatment.