CASE REPORT article
Front. Ophthalmol.
Sec. Neuro-Ophthalmology Disorders
This article is part of the Research TopicThe Challenge: Viral Infections and Initiation of Acute and Persistent Pain PhenotypesView all 5 articles
From Paroxysmal Hemicrania to SUNCT: A Unique Presentation of Herpetic Zoster Ophthalmicus: A case report
Provisionally accepted
- 1National Cheng Kung University Hospital, Tainan, Taiwan
- 2Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan
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Background: Trigeminal autonomic cephalalgias (TACs) are characterized by unilateral headache with cranial autonomic symptoms. Sudden subtype changes may suggest secondary causes. Case Presentation: A 66-year-old woman presented with a rapid shift from paroxysmal hemicrania to SUNCT. Varicella zoster virus (VZV) reactivation was confirmed by CSF analysis and aqueous humor PCR. Ocular involvement included panuveitis and papillitis. Symptoms resolved after 14 days of intravenous acyclovir. Conclusion: Rapid TACs subtype transformation should prompt evaluation for secondary causes. Early diagnosis of VZV can lead to favorable outcomes.
Keywords: Headache, TACs, Trigeminal Autonomic Cephalalgias, VZV infection, herpetic zoster ophthalmicus
Received: 14 May 2025; Accepted: 03 Dec 2025.
Copyright: © 2025 Tsai, Su and Chang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hui-Chen Su
Yu-Ming Chang
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