SUNCT headache symptoms and treatments

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SUNCT is a rare condition that causes bursts of pain. The term “SUNCT” stands for:

• short-lasting, as each attack usually lasts between 5 seconds and 4 minutes
• unilateral, which means the pain only occurs on one side of the head
• neuralgiform, meaning the pain resembles nerve pain
• conjunctival injection, which refers to bloodshot or red eyes
• tearing, meaning the condition causes eye watering

SUNCT most often affects males. It may be a form of trigeminal neuralgia, which is pain affecting the fifth cranial nerve.

The main symptom of SUNCT is short moderate-to-severe bursts of pain that may be:

• throbbing
• burning
• piercing

The pain affects one side of the head, along with the eye and temple area on the same side. It will usually reach a peak within seconds. Typically, the attacks happen in the daytime, and individuals usually experience five to six attacks per hour.

Aside from the pain, the condition also causes autonomic symptoms, or symptoms that relate to automatic bodily functions. These can include:

• bloodshot or reddish eyes
• watery eyes
• runny nose
• nasal congestion
• increased pressure in the eye on the affected side
• swelling of the eyelid
• sweaty forehead

Additionally, systolic blood pressure may increase during the attack. This is the pressure inside the arteries during heartbeats.

In many cases, doctors cannot find a specific cause for SUNCT, but sometimes it is the result of lesions, cysts, or tumors in the brain. An older 2012 review of previous research also notes connections to:

• trauma or injury, including to the eye area
• brainstem stroke
• artery malformations in the brain
• tears in the vertebral artery
• neurofibromatosis, a genetic condition that causes tumors to grow along nerves
• HIV, in rare cases

Attacks may occur spontaneously, or they may have triggers, such as:

• touching the forehead or eye area
• chewing
• making facial expressions
• moving the neck

A 2022 study also lists temperature and odor changes as triggers.

SUNA stands for “short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms.” Both SUNCT and SUNA belong to the family of headache conditions known as trigeminal autonomic cephalgias (TACs).

TACs are primary headaches associated with the trigeminal nerve that cause pain on one side of the face or head. “Primary” means they do not occur as a result of another condition or medication.

Although SUNCT and SUNA are similar, there are slight distinctions between them. SUNCT causes the autonomic symptoms of tearing and eye redness, while SUNA can cause any autonomic symptoms. SUNA attacks also tend to last longer, at up to 10 minutes.

Vs. cluster headaches

An older 2001 review explains the differences between SUNCT and cluster headaches. They are both TACs and have many similarities, but cluster headaches:

• have a longer duration
• tend to occur at night
• respond to headache medications
• manifest:
  • ptosis, or drooping of the upper eyelid
  • miosis, or very small pupil size
  • reduced forehead sweating

Vs. other TACs

While SUNCT, SUNA, and cluster headaches are TACs, this category also includes two other conditions. There is hemicrania continua, which involves constant long-lasting pain, and paroxysmal hemicrania, which causes five or more severe pain attacks that last up to 30 minutes per day.

Vs. trigeminal neuralgia

Although SUNCT may be a form of trigeminal neuralgia, it differs from standard trigeminal neuralgia in two ways. Unlike trigeminal neuralgia, symptoms such as runny nose and watery eyes accompany SUNCT. SUNCT also tends to be resistant to therapies for trigeminal neuralgia.

Doctors base a diagnosis of SUNCT on a person’s symptoms. To get a diagnosis, a person must have had at least 20 attacks with:

• a pulsating or stabbing pain in the eye, under-eye, and temple area on one side of the head
• a duration of 1–600 seconds
• eye symptoms and tearing accompanying the pain

Medical imaging may be necessary to check for lesions or growths.

A SUNCT headache generally does not respond to treatments for other short-term headaches. While there is no cure, treatment options include:

• carbamazepine (Tegretol), an antiseizure medication
• topiramate (Topamax), an antiseizure medication
• oxcarbazepine (Oxtellar XR), an antiseizure medication
• gabapentin (Neurontin), an antiseizure medication
• lamotrigine (Lamictal), an antiseizure medication
• intravenous lidocaine (Xylocaine), a numbing medication

Surgical interventions may help, but doctors only consider them if medications do not work. These include:

• microvascular decompression of the trigeminal root, which is the insertion of a pad between a blood vessel and the nerve root to relieve pressure
• percutaneous trigeminal ganglion compression, which is a procedure that puts pressure on a collection of nerves at the root of the trigeminal nerve for a short time
• deep brain stimulation, which delivers electrical pulses to a brain area from an implant

A SUNCT headache is a throbbing, burning, or piercing pain that affects one side of the head in short bursts. Aside from pain, the condition causes autonomic symptoms, such as bloodshot eyes, a runny nose, and sweaty forehead.

Doctors base a diagnosis on symptoms, and sometimes, medical imaging. No single treatment helps every person, but several medications may provide pain relief. When no medication works, surgical interventions may be available.