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Clomiphene Citrate as a New Treatment for SUNCT: Hormonal Manipulation for Hypothalamic-Influenced Trigeminal Autonomic Cephalalgias


  • Todd D. Rozen MD,

  • Joel R. Saper MD, FACP, FAAN,

  • Fred D. Sheftell MD,

  • David W. Dodick MD, FRCP(C), FACP

  • From the Michigan Head Pain & Neurological Institute, Neurology, Ann Arbor, MI (Drs. Rozen and Saper); The New England Center for Headache, Stamford, CT (Dr. Sheftell); and Mayo Clinic College of Medicine, Neurology, Scottsdale, AZ (Dr. Dodick).

Address all correspondence to Dr. Todd Rozen, MHNI, 3120 Professional Drive, Ann Arbor, MI.


We present a patient with treatment refractory short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) who was found to have low levels of serum testosterone supporting the hypothalamic connection to this trigeminal autonomic cephalalgia. Clomiphene citrate therapy induced a significant elevation of testosterone levels (by its effect on hypothalamic estrogen receptors) and led to a dramatic reduction in SUNCT attacks. Hormonal manipulation may be a treatment strategy for hypothalamic-influenced trigeminal autonomic cephalalgias.