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SUNCT Syndrome — SCE Neurology MCQ

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HardHeadache & Facial PainSUNCT SyndromeSCE Neurology

A woman has hundreds of strictly unilateral orbital attacks daily, each lasting 10–60 seconds with conjunctival injection and tearing. There is no refractory period and MRI excludes a secondary lesion. Which diagnosis is most likely?

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Correct answer: D — Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)

The best answer is “Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)”. Very brief, very frequent unilateral attacks with conjunctival injection and tearing define SUNCT within the trigeminal autonomic cephalalgias. “Cluster headache with attacks lasting 15–180 minutes” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Paroxysmal hemicrania with longer attacks and an absolute indometacin response” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Trigeminal neuralgia without prominent cranial autonomic features” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Migraine with aura followed by seconds of orbital pain” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here.

Reference: ICHD-3 short-lasting unilateral neuralgiform headache attacks: https://ichd-3.org/3-trigeminal-autonomic-cephalalgias/3-3-short-lasting-unilateral-neuralgiform-headache-attacks/