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