SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) is one of the rarest of all primary headache syndromes. It is one of the trigeminal autonomic cephalalgias, along with cluster headache and paroxysmal hemicrania. It is marked by frequent, short-lasting attacks of 1-sided headache with associated cranial autonomic symptoms. SUNCT forms the majority subset of SUNA (short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms), in which the combination of conjunctival injection and tearing are not required for diagnosis. Reports and series have shown therapeutic benefits with medical treatments. Structural imaging studies report an association with aberrant vessel in contact with the trigeminal nerve, and functional imaging studies report hypothalamic activation. Microvascular decompression, occipital nerve stimulation, posterior hypothalamic region deep brain stimulation, and focal radiation therapy have all been reported to be effective in medically intractable cases.
In this article, Dr. Hans-Christoph Diener of the University of Essen discusses the clinical manifestations, biological basis, diagnosis, and management of SUNCT syndrome.
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