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Chapter 2, Episode 6: What is SUNCT and SUNA?

Published: October 13, 2022

TRANSCRIPT

This content has been medically reviewed by Dr. Jihan Grant.

SUNCT and SUNA are two rare types of trigeminal autonomic cephalgias with an estimated prevalence of 6.6 out of every 100,000 people. Trigeminal autonomic cephalgias are a group of headache types that cause one-sided head and/or facial pain and autonomic symptoms such as a runny or stuffy nose, a sensation of fullness in the ear, facial sweating and flushing. 

First, let’s discuss SUNCT:

SUNCT stands for Short-lasting Unilateral Neuralgiform with Conjunctival Injection and Tearing 

meaning… 

  • Short lasting – Attacks typically last anywhere from 1 second to 10 minutes
  • Unilateral – occurs on one side of the head
  • Neuralgiform – Feels like nerve pain
  • Conjunctival Injection – Red eye
  • Tearing – Generating tears from the eye

Next is SUNA which stands for Short- lasting Unilateral Neuralgiform with cranial Autonomic symptoms. 

  • Short lasting – attacks typically last anywhere from 1 second to 10 minutes
  • Unilateral – occurs on one side of the head
  • Neuralgiform – Feels like nerve pain
  • Autonomic – Symptoms are involuntary

To receive a diagnosis of SUNCT or SUNA a person must have had at least 20 attacks. Attacks must occur at least once per day. They usually cause moderate to severe pain on one side, around the eye or in the temporal region of the head and must include at least one of the cranial autonomic symptoms. A person with SUNCT must have both a red eye and tearing on the same side as the pain. A person with SUNA must have only one or neither of those eye symptoms. 

Episodic SUNCT or SUNA is defined as having attacks that occur for a period of 7 days to 1 year followed by symptom free periods of 3 months or more. 

Chronic SUNCT or SUNA is defined as having attacks for more than one year without a symptom free period or with a symptom free period less than 3 months. 

Attacks may occur up to 200 times in one day. People may characterize these attacks as a single or group of stabbing, jabbing, throbbing, shooting or electric shock-like pains.

Some attacks may be triggered by touching the skin on the face or neck movement.

An MRI of the brain is needed before diagnosis to check for other causes of symptoms. A provider may also consider imaging the blood vessels of the head to look for abnormalities.

Treatment is the same for both SUNCT and SUNA. Acute treatment is difficult because the attacks are so short but intravenous lidocaine can be helpful. Lamotrigine is the recommended preventive treatment. Other preventive treatments include: oxcarbazepine, carbamazepine, gabapentin, topiramate and others. For those who do not find relief with these medications, greater occipital nerve blocks and occipital nerve stimulation are alternative options. 

Unlike paroxysmal hemicrania and hemicrania continua, SUNCT and SUNA do NOT respond to indomethacin. 

It is important to keep a log of the frequency, duration and characteristics of your symptoms so your doctor can accurately diagnose this condition. 

For more information, visit: migrainedisorders.org

This video is sponsored in part by Praxis.

*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.