Sunct/suna

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic features (SUNA) are currently classified in the section of the trigeminal autonomic cephalalgias as separate subtypes of the same disorder (short-lasting unilateral neuralgiform headache attacks). There is no therapy consistently effective for SUNCT or SUNA. During the worst periods intravenous lidocaine or phenytoin may decrease the frequency of SUNCT/SUNA attacks. Lamotrigine is the drug of choice for the preventive treatment of SUNCT, but it is less effective for SUNA. Gabapentin may be also effective for both SUNCT and SUNA. Topiramate can be effective in SUNCT, but it has not shown an effect in SUNA. Some medically refractory cases have obtained benefit from surgical procedures. These include microvascular decompression of the trigeminal nerve, ablative procedures involving the trigeminal nerve, Gasserian ganglion or sphenopalatine ganglion, occipital nerve stimulation, and hypothalamic deep brain stimulation.