(See also Approach to the Patient With Headache Approach to the Patient With Headache Headache is pain in any part of the head, including the scalp, face (including the orbitotemporal area), and interior of the head. Headache is one of the most common reasons patients seek medical... read more .)
SUNCT, like cluster headache Cluster Headache Cluster headaches cause excruciating, unilateral periorbital or temporal pain, with ipsilateral autonomic symptoms (ptosis, lacrimation, rhinorrhea, nasal congestion). Diagnosis is clinical... read more , 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 Trigeminal Neuralgia Trigeminal neuralgia is severe paroxysmal, lancinating facial pain due to a disorder of the 5th cranial nerve. Diagnosis is clinical. Treatment is usually with carbamazepine or gabapentin; sometimes... read more , 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.
