Face / Head / Neck

SUNCT

Definition

SUNCT is the abbreviation for Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing rhinnorhoea and forehead sweating. SUNCT is a rare disorder that, according the International Classification of Headache, is classified with cluster headache and paroxysmal hemicrania, under TAC (Trigeminal Autonomic Cephalalgia).

 

Aetiology

Although there is supposed involvement of the posterior hypothalamus, the aetiology of SUNCT is unknown. Central inhibition of the autonomic reflex in the trigeminal nerve may play a role.

Signs and symptoms

Patients complain of a short-lasting, unilateral stabbing and throbbing headache (lasting from 5 to 240 seconds) that is accompanied by tears and redness of the conjunctiva. Fifty percent of patients are not free of pain between the attacks. Other autonomic symptoms are nasal congestion, eyelid oedema, sweating and/or flushed face.

Diagnostics

Physical Examination

 

The diagnosis is made from the clinical picture. Extensive neurological examination, particularly of the cranial nerves is indicated.

Patients do not respond to indomethacin, which is typical of this condition.

Additional Somatic Diagnostics

In order to exclude pathology in the posterior fossa and the hypophysis, MRI scan is indicated.

 

Additional Psycho-cognitive Diagnostics

  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

  • Oxygen inhalation (100%, 12 litre/min) to put a stop to attacks
  • Intravenous lidocaine 1.5-3.5 mg/kg/hour to put a stop to attacks
  • Gabapentine, lamotrigine and topiramate (preventive)

Interventional pain treatment