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

By

Stephen D. Silberstein

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Apr 2020| Content last modified Apr 2020
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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 seconds. Conjunctival injection is often the most prominent autonomic feature; tearing may also be obvious.

Diagnosis of SUNCT

  • Clinical evaluation

Diagnosis of SUNCT is clinical. MRI or CT is done to rule out other possible causes such as a pituitary tumor

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 of SUNCT

  • For acute attacks, IV lidocaine

  • For prevention, antiseizure drugs and/or occipital nerve stimulation or blockade

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

Drugs Mentioned In This Article

Drug Name Select Trade
INDOCIN
LAMICTAL
TOPAMAX
NEURONTIN
XYLOCAINE
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