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Professional /
Neurologic Disorders /
Headache /
... /
Short-Lasting Unilateral Neuralgiform Headache With Conjunctival Injection and Tearing (SUNCT) /
IN THIS TOPIC

Diagnosis

Treatment

OTHER TOPICS IN THIS CHAPTER

Headache
Approach to the Patient With Headache
Cluster Headache
Idiopathic Intracranial Hypertension
Medication Overuse Headache
Migraine
Post–Lumbar Puncture and Other Low–Pressure Headaches
Short-Lasting Unilateral Neuralgiform Headache With Conjunctival Injection and Tearing (SUNCT)
Tension-Type Headache

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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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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version

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.

(See also Approach to the Patient With Headache.)

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

  • 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

  • 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
Indomethacin
 INDOCIN
lamotrigine
 LAMICTAL
topiramate
 TOPAMAX
gabapentin
 NEURONTIN
lidocaine
 XYLOCAINE
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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
© 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA)
Post–Lumbar Puncture and Other Low–Pressure Headaches
Tension-Type Headache
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