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SUNCT syndrome — SCE Neurology MCQ

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ModerateHeadacheSUNCT syndromeSCE Neurology

A 31-year-old man presented with very frequent short unilateral stabbing orbital pains with conjunctival injection and tearing. On examination, attacks lasted under two minutes and occurred dozens of times daily. Initial investigations showed: MRI pituitary and posterior fossa was normal. What is the most likely diagnosis?

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Correct answer: A — SUNCT syndrome

SUNCT syndrome is the best answer because the vignette describes SUNCT syndrome: brief frequent neuralgiform attacks with conjunctival injection and tearing indicate SUNCT. Low-pressure headache is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Giant cell arteritis and Cerebral venous sinus thrombosis headache are less appropriate because they would require different localisation, timing or test findings; Migraine with aura would fit a different syndrome. Clinical pearl: cluster headache attacks are longer and less frequent.

Reference: British Association for the Study of Headache: SUNCT and SUNA. https://bash.org.uk/2-4-3-sunct-suna/