red eye

8 May 2017

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 SUNA What 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 â€“ 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.

For more information, see:

7 January 2013

Eye Redness and Headache

James Tips 8

What does it mean when you have eye redness and headache? Answering the question quickly was my challenge. Here’s my first try at a quick tip feature which I would like to do regularly here at Headache and Migraine News…

Eye redness and headache - quick tip

26 February 2009

First Migraine then Bloodshot Eye – What’s up?

James Information 7

So you had what seemed to be a migraine attack. First migraine then bloodshot eye. A bloodshot eye? Is that a symptoms of migraine?

First I should ask what you mean by a "bloodshot eye". You could mean that you actually have a large red patch in your eye. That is what is called a subconjunctival hemorrhage. This happens when one of the tiny blood vessels in the membrane covering your eye bursts. Though it looks terrible, it’s usually harmless and goes away in a few days to a couple of weeks. The hemorrhage itself is generally not painful (if it is, talk to your doctor).

A bloodshot eye from an infection

A subconjunctival hemorrhage is rarely associated with migraine.

On the other hand, some people talk about bloodshot eyes and are referring to inflammation. When the blood vessels become inflamed, they become more red and prominent in the eye. This type of bloodshot eye, or red eye, is actually very common in migraine.

This migraine attack may include not only red eyes but watery eyes. The symptoms, along with the congestion that often comes along with migraine, lead many to believe they have a "sinus headache".

Why a Migraine then Bloodshot eye? Possible cause…

As a migraine attack progresses, it causes inflammation, especially around the head and facial area. It’s this inflammation that may cause the symptoms around the eyes and nose, such as a runny nose, watery eyes, and congestion. This part of the inflammation probably starts with the trigeminal nerve and spreads.

So what can be done?

If the bloodshot eye is simply part of the migraine attack, migraine treatment should resolve the red eyes along with everything else. However, this brings us to a couple of warnings.

Are you sure it’s Migraine?

If you’re experiencing new symptoms, or your symptoms have changed, you should talk to a doctor who knows your medical history. A bloodshot eye could be a sign of something else, and to treat it you need to know what you’re dealing with. For example, glaucoma, which may also make you nauseous and sensitive to light.

A bloodshot eye is actually a much more common symptom of cluster headache. Cluster headache pain is often localized around one eye, one side of the temple, or in the upper jaw. Like migraine, symptoms may include congestion. The eye may become red, and the eyelid may droop.

During a cluster headache, the person becomes agitated and may pace the floor, where migraine patients more commonly want to lie down in a dark room.

These are called "clusters" because they come in cycles of several weeks or months, then they disappear for months or even years. The headaches generally last from 15 to 3 hours, and will repeat from every other day to several times a day.

If these symptoms sound like you, you may have cluster headache. But either way, if you’re having new symptoms, or you’re not sure, talk to your doctor.

The migraine then bloodshot eye sequence is not unusual. Read here for more on the strange symptoms of migraine.