SUN: Short‐Lasting Unilateral Neuralgiform Headache Attacks

Abstract

This article discusses the clinical aspects of the syndrome, pathophysiology, current, and future treatments.

Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach

“…SUNCT/SUNA are, although a matter of debate, considered primary headache disorders; however, secondary cases are increasingly being described in the literature, for example, due to neurovascular conflicts, white matter lesions, and pituitary lesions [37,38]. Treatment of SUNCT/SUNA differs from that of TN or other TACs with lamotrigine, topiramate, and gabapentin as the preferred preventive treatment medications [39][40][41][42]. The first-line treatment for SUNCT/ SUNA exacerbations is intravenous lidocaine.…”

Acute Herpes Zoster Infection With Onset of SUNA: A Rare Case and Literature Review

“…The pathophysiological mechanism of SUNA remains unclear. Involvement of the hypothalamus, trigeminal autonomic reflex, and trigeminal cervical complex may account for the pain attacks and autonomic symptoms in trigeminal autonomic cephalalgia, including SUNA, by both central and peripheral mechanisms . Herpes zoster virus infection can cause degeneration of afferent nociceptive C fibers and reorganization of synapses.…”

“…Involvement of the hypothalamus, trigeminal autonomic reflex, and trigeminal cervical complex may account for the pain attacks and autonomic symptoms in trigeminal autonomic cephalalgia, including SUNA, by both central and peripheral mechanisms. 7,8 Herpes zoster virus infection can cause degeneration of afferent nociceptive C fibers and reorganization of synapses. These changes lead to formation of new functional synapses in the dorsal horn lamina II and result in aberrant alterations in the nociceptive afferent pathways.…”

The SUN Also Rises

“…This issue of Headache Currents contains two masterful clinical reviews on short‐lasting unilateral headache attacks by two of the leading experts on these disorders, Drs. Raphael Benoliel et al and Anna Cohen . The International Classification of Headache Disorders (ICHD‐3) Beta places the two previously proposed trigeminal autonomic cephalalgias (TACs), short‐lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short‐lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) under the rubric of short‐lasting unilateral headache attacks…”

“…If so, this may reflect a spectrum of disease ranging from typical CTN attacks to typical SUNHAs with a mixed phenotype in the middle. In this review, we will summarize the overlap between these entities and contrast the pathophysiology and treatment approach.” Dr. Cohen also describes the differential diagnosis challenge in the section of her paper entitled, “SUNCT, SUNA, and Trigeminal Neuralgia.”…”