SUNA and SUNCT

Short-lasting unilateral neuralgiform headache attacks with cranial autonomic sympoms (SUNA) and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) are similar, rare headache disorders in which patients experience attacks of severe pain over the eye, forehead, and/or temple. These attacks are brief, lasting up to a few minutes, and they are accompanied by one or more autonomic nervous system symptoms affecting the eye and face: eye watering and redness, drooping eyelid, changes in pupil size, runny nose or nasal congestion, facial flushing or sweating, and others. SUNCT is a subtype of SUNA and is much more common among men than women.

SUNA/SUNCT attacks can either be spontaneous or triggered, with common triggers including touching the face, showering, shaving, chewing, talking, and neck movements, among others. The cause of SUNA/SUNCT is still debated. Importantly, the disorders should not be confused with trigeminal neuralgia, which is far more common. Commonly used medications for SUNA/SUNCT include lamotrigine, topiramate, and gabapentin. For patients who are severely affected despite medications, surgery should be considered.

It’s important to distinguish SUNA/SUNCT from trigeminal neuralgia because some surgical treatments for trigeminal neuralgia may not only be ineffective for SUNA/SUNCT but may actually cause harm. In particular, procedures that damage the trigeminal nerve (such as trigeminal rhizotomy) should be avoided in SUNA/SUNCT. The surgeries that have shown the most promise for SUNA/SUNCT are microvascular decompression, sphenopalatine ganglion (SPG) rhizotomy, and occipital nerve stimulation.

SUNA/SUNCT can be challenging because it is an uncommon problem that is often misdiagnosed. Once properly identified, however, there are effective treatments. If you have SUNA/SUNCT or a related facial pain disorder, please consider meeting me in consultation to learn more about options for finding relief from your pain.