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SUNCT Syndrome

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

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What is SUNCT Syndrome?

SUNCT syndrome (Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing) is a rare primary headache included in trigeminal autonomic cephalalgia (TAC); when accompanied only by autonomic features other than conjunctival injection-lacrimation, it is called SUNA (Short-lasting Unilateral Neuralgiform headache attacks with Autonomic symptoms). 2013 ICHD-3 grouped both as 'Short-lasting Unilateral Neuralgiform headache attacks (SUNHA)'.

Diagnostic criteria: severity moderate-severe, unilateral, in trigeminal nerve V1 distribution, lasting 1-600 seconds, frequency at least 1 attack/day during active period, accompanied by ipsilateral conjunctival injection AND lacrimation (SUNCT) or one or more autonomic findings (SUNA). At least 20 attacks must have occurred. Pain is described as 'electric shock-like, stabbing, burning, jolting'.

Frequency: 3-200 attacks/day (median 28), often clustered, periodic active periods + spontaneous remissions. Trigger: 50-90% of patients have triggers - face, scalp, intraoral touch (especially V1 territory), chewing, talking, brushing teeth, washing face. Refractory period absent (different from trigeminal neuralgia). Etiology: hypothalamic activation (PET-MR functional study), trigeminal nerve hyperexcitability. Differential diagnosis: trigeminal neuralgia (more often V2-V3, no autonomic finding, refractory period present), short-lasting cluster headache (longer attack, autonomic), primary stabbing headache (without autonomic finding).

Symptoms

Severe unilateral periorbital, retro-orbital pain (V1 distribution)
Pain duration: 1-600 seconds (often 5-240 seconds)
Pain quality: electric shock-like, stabbing, burning
Frequency: 3-200 attacks/day (median 28)
Cranial autonomic findings (mandatory):
- Conjunctival injection (red eye)
- Lacrimation (tearing)
- Sometimes: ptosis, miosis (Horner-like)
- Nasal congestion-rhinorrhea
- Eyelid edema
- Forehead-facial sweating
Trigger areas: face, scalp, intraoral, chewing, talking
Sometimes restless feeling, agitation
Decline in quality of life (frequent painful attacks)
Avoidance of work and social activity

Risk Factors

Male sex (1.5:1)
Middle-advanced age (40-70)
Family history rare
Secondary causes (5-10%):
- Vascular conflict in posterior fossa (intracranial vessel-trigeminal nerve contact)
- Pituitary tumor
- Cavernous sinus pathology
- Brainstem lesion
- Multiple sclerosis (rare)
- HIV related
- Trauma history
Prior trigeminal neuralgia history (in some patients)
Migraine, cluster headache history (overlap)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Severe unilateral, periorbital pain attacks
  • Recurrent attacks of very short pain (1-10 minutes)
  • Eye redness, tearing accompanied by pain
  • Trigger area sensitivity (face, intraoral)
  • Frequent recurrent painful attacks (daily life decline)
  • Trigeminal neuralgia diagnosis + autonomic findings
  • Sudden severe headache + new neurologic findings
  • Pain change after age 50 (red flag - secondary cause)

Treatment Methods

01
Detailed headache history (location, duration, autonomic findings)
02
Brain MRI + MR angiography + brainstem high-resolution sequence (mandatory):
03
- Pituitary tumor exclusion
04
- Vascular conflict (trigeminal-cerebellar artery)
05
- Multiple sclerosis plaque
06
- Cavernous sinus, brainstem lesion
07
Prophylactic treatment (long-term):
08
- Lamotrigine 100-400 mg/day (first-line, slow titration - SJS risk)
09
- Topiramate 50-400 mg/day (alternative)
10
- Gabapentin 800-3600 mg/day
11
- Pregabalin 75-600 mg/day
12
- Carbamazepine, oxcarbazepine (limited effective)
13
- Duloxetine, mexiletine (selected)
14
Acute attack treatment (limited effective due to short duration):
15
- IV lidocaine infusion (severe exacerbation, hospitalization)
16
- IV phenytoin (acute)
17
- Triptan, oxygen ineffective
18
Local interventions (refractory):
19
- Greater occipital nerve block (steroid + lidocaine)
20
- Sphenopalatine ganglion block
21
- Onabotulinumtoxin A injection
22
Surgical-neuromodulation options (severe refractory):
23
- Microvascular decompression (vascular conflict identified)
24
- Gamma knife trigeminal radiosurgery
25
- Hypothalamic deep brain stimulation (DBS)
26
- Occipital nerve stimulation
27
- Sphenopalatine ganglion stimulation
28
Trigger avoidance (face touch, dental hygiene careful)
29
Long-term follow-up: lamotrigine slow titration, drug interaction
30
Multidisciplinary headache center evaluation

Which Department to Visit?

You can visit our Nöroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.