Headache

SUNCT Syndrome

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SUNCT Syndrome, SUNCT Headache, Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection or Tearing, SUNA Headache, Short-Lasting Unilateral Neuralgiform Headache Attacks with Cranial Autonomic Symptoms

  • Classification
  1. Short duration
  2. Trigeminal Autonomic Cephalgia
    1. Headaches similar to Cluster Headache
    2. Unilateral trigeminal distribution symptoms with autonomic features
  • Symptoms
  1. Region
    1. Unilateral orbital, supraorbital or temporal Headache
  2. Characteristics
    1. Stabbing or pulsating pain
  3. Timing
    1. Duration <4 minutes per episode
    2. Recurrs for 3-200 attacks/day
  4. Associated Symptoms (autonomic findings)
    1. Ipsilateral Conjunctival injection
    2. Ipsilateral Lacrimation
  • Diagnosis
  1. Characteristics: At least 20 or more Headaches meeting the following criteria
    1. Severe to very severe unilateral orbital, supraorbital or temporal pain lasting seconds to 10 minutes
      1. Occurs as single stab or multiple stabs
    2. Headaches at least once daily
    3. At least 2 Headaches last 7 days to 1 year (when untreated)
    4. Headache with at least one of the following ipsilateral autonomic symptoms
      1. Conjunctival injection or Lacrimation
      2. Nasal congestion or Rhinorrhea
      3. Eyelid Edema
      4. Forehead and facial sweating
      5. Miosis or Ptosis
  2. Timing
    1. Episodic
      1. Headaches with pain-free periods >3 month
    2. Chronic
      1. Episodes recur for more than 1 year without remission or with remission <3 month
  3. References
    1. (2018) Cephalgia 38(1):1-211 [PubMed]
  • Differential Diagnosis
  • Management
  1. No established definitive management
  2. See Cluster Headache for potential management options