SUNCT Syndrome — SCE Neurology MCQ

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HardHeadache & Facial PainSUNCT SyndromeSCE Neurology

A 40-year-old man presents with episodic severe headache with unilateral conjunctival injection, lacrimation, facial sweating, miosis, and ptosis. Attacks last 2–5 minutes and occur 30–60 times per day. They are triggered by cutaneous stimulation of the ipsilateral forehead. What diagnosis should be considered?

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Correct answer: A — SUNCT syndrome (Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing)

SUNCT is a trigeminal autonomic cephalalgia characterised by very brief attacks (5 seconds to 4 minutes, typically 1–2 minutes), very high frequency (3 to 200 attacks/day), unilateral periorbital pain with prominent ipsilateral conjunctival injection and lacrimation, and cutaneous triggers (touching the face/forehead). The related condition SUNA (Short-lasting Unilateral Neuralgiform headache attacks with cranial Autonomic symptoms) has autonomic features other than just CI and tearing. Key differentiating features: SUNCT attacks are much shorter and more frequent than cluster headache, and are triggered by cutaneous stimuli. Treatment: lamotrigine is the most effective preventive. A: Cluster attacks last 15–180 minutes. C: PH attacks last 2–30 minutes. D: Migraine lasts 4–72 hours. E: TN is even briefer and lacks autonomic features.

Reference: ICHD-3; ABN Headache Guidelines