A Nail in the Head: Short-lasting Unilateral Neuralgiform Headache Attacks

An article with “short-lasting unilateral neuralgiform headache attacks” in the title isn’t necessarily going to catch your attention, but if you’ve experienced this type of headache, you know it’s not something that can be ignored.

Earlier this week we saw a video of Rev. David Wakefield, who has both chronic cluster headache and SUNCT, a form of the headache we’ll be talking about today. If you missed the video, see New Device Approved by FDA to Fight Cluster Headache (video).

SUNCT and SUNAWhat is officially called short-lasting unilateral neuralgiform headache attacks is actually one type of chronic daily headache. The headaches last only seconds or minutes (as long as ten minutes), but they are very painful and hit you at least once a day. The pain is on one side of the head, and the eye on that side will usually get red and watery.

As the title to this article implies, the pain is often described as “stabbing”, like a nail in the head.

With the red eye and tearing, the diagnosis is usually SUNCT, which stands for short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. That’s the version that Rev. Wakefield deals with.

If there is tearing (watery eye) or red eye, or neither, the diagnosis may be SUNA, or short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms. These headaches are accompanied by other symptoms that may occur in SUNA or SUNCT, such as congestion, facial sweating, and drooping or swelling or the eyelid.

Because of the congestion and tearing, SUNCT or SUNA may actually be misdiagnosed as sinus headache (more commonly, migraine is misdiagnosed as sinus headache – see Sinus Headache – Did You Really Beat It?).

Technically, the condition is considered “chronic” when it continues for a year or more, with less than a month pain-free.

Treatment of SUNCT and SUNA

There are some treatments that seem to help some people, but there have not been enough clinical trials to come up with consistent solutions (if they exist – treatment may be a very individual thing, especially until our understanding of the condition grows). Because the attacks are so brief, abortive treatment (stopping individual attacks) is not a major focus. Intravenous lidocaine or a phenytoin injection are sometimes used to try to stop a series of attacks.

To prevent attacks, medications such as lamotrigine, carbamazepine, gabapentin, and topiramate seem to help some patients, and nerve blocks may provide temporary relief.

Sometimes a certain cause is found for these symptoms, in which case treatment will vary. For example, compression of the trigeminal nerve or a structural lesion.

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