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Short-Lasting Unilateral Neuralgiform Headache With Conjunctival Injection and Tearing (SUNCT)

By Stephen D. Silberstein, MD, Professor of Neurology and Director, Headache Center, Sidney Kimmel Medical College at Thomas Jefferson University

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Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is a rare headache disorder characterized by extremely frequent attacks of unilateral head pain and autonomic activation.

SUNCT, like cluster headache, is a primary headache disorder characterized by unilateral pain in the trigeminal nerve distribution and by autonomic manifestations. As such, SUNCT and cluster headaches are sometimes grouped together as trigeminal autonomic cephalgias.

In SUNCT, pain paroxysms are typically periorbital, are extremely frequent (up to 200/day), and last from 5 to 250 sec. Conjunctival injection is often the most prominent autonomic feature; tearing may also be obvious.


  • Clinical evaluation

Diagnosis of SUNCT is clinical.

SUNCT should be distinguished from trigeminal neuralgia, which causes similar symptoms; SUNCT differs in that

  • It has no refractory period.

  • Pain occurs predominantly in the ophthalmic division of the trigeminal nerve.

  • Attacks are not triggered by cutaneous stimuli.

  • Indomethacin does not relieve symptoms, as it does in some other headache disorders.


  • For acute attacks, IV lidocaine

  • For prevention, anticonvulsants and/or occipital nerve stimulation or blockade

Treatment of SUNCT can include IV lidocaine for acute attacks and, for prevention, anticonvulsants (eg, lamotrigine, topiramate, gabapentin) and occipital nerve stimulation or blockade.