What are SUNA and SUNCT?
Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (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. SUNCT is a subtype of SUNA and is much more common among men than women.
What do the attacks feel like?
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. 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.
What causes SUNA and SUNCT?
The cause of SUNA/SUNCT is still debated. Importantly, the disorders should not be confused with trigeminal neuralgia, which is far more common.
How are SUNA and SUNCT treated?
Commonly used medications for SUNA/SUNCT include lamotrigine, topiramate, and gabapentin. For patients who are severely affected despite medications, surgery should be considered.
Why is it important to distinguish SUNA and SUNCT from trigeminal neuralgia?
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 avoidedin SUNA/SUNCT. The surgeries that have shown the most promise for SUNA/SUNCT are microvascular decompression, sphenopalatine ganglion (SPG) rhizotomy, and occipital nerve stimulation (which I no longer offer).
Why are SUNA and SUNCT often misdiagnosed?
SUNA/SUNCT can be challenging because it is an uncommon problem that is often misdiagnosed. Once properly identified, however, there are effective treatments.
Should I meet with you?
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.