Consider SUNCT/SUNA

SUNCT/SUNA

Short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) also manifests itself as a one-sided headache and is associated with the cranial autonomic symptoms as described in cluster headache (CH).

It can be distinguished from other closely similar primary headaches because of the usually very brief attack duration (15-120 seconds) which can occur very frequently (up to 30 per hour), and the presence of extremely prominent tearing and redness of the eye on the same side as the pain.

There is a very similar syndrome to SUNCT which is called short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) where there may be cranial autonomic symptoms other than red eye and tearing, or only one of these may be present.

If this brief description does not match your headache type, consider Trigeminal Neuralgia and/or Primary Stabbing Headache.

Treatment

Until recently, SUNCT and SUNA were thought to be very difficult to treat, but on the basis of the limited, open-label data available in the medical literature, lamotrigine is the first treatment of choice, while topiramate and gabapentin are reasonable second-line agents in sufferers who fail to respond to this. Other options include carbamazepine, intravenous lidocaine (for short term management), corticosteroids and sumatriptan. Several surgical techniques may also be considered.