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

by Stephen D. Silberstein, MD

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.

Diagnosis

Diagnosis 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.

Treatment

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

Drugs Mentioned In This Article

  • Drug Name
    Select Trade
  • INDOCIN
  • NEURONTIN
  • TOPAMAX
  • LAMICTAL
  • XYLOCAINE

* This is a professional Version *