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Short-Lasting Unilateral Neuralgiform Headache Attacks.

Andrew Levy1, Manjit S Matharu1

  • 1Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.

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|May 4, 2018
PubMed
Summary

Short-lasting unilateral neuralgiform headache attacks (SUNHA), including SUNCT and SUNA, are rare but disabling. Emerging evidence suggests SUNHA, SUNCT, and SUNA may be part of a continuum with trigeminal neuralgia, potentially requiring reclassification.

Keywords:
Short-lasting unilateral neuralgiform headache attacksshort-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearingshort-lasting unilateral neuralgiform headache attacks with cranial autonomic symptomstrigeminal autonomic cephalalgias

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Area of Science:

  • Neurology
  • Headache Medicine

Background:

  • Short-lasting unilateral neuralgiform headache attacks (SUNHA) encompass SUNCT and SUNA, characterized by unilateral trigeminal pain and autonomic features.
  • These conditions are rare, highly disabling, and pose management challenges due to short attack durations and limited abortive therapy effectiveness.

Purpose of the Study:

  • To review the management strategies for SUNHA, including pharmacological and surgical interventions.
  • To explore the potential nosological overlap between SUNHA (SUNCT/SUNA) and trigeminal neuralgia (TN).

Main Methods:

  • Review of pharmacological preventive treatments, including lamotrigine and lidocaine.
  • Analysis of surgical interventions such as trigeminal nerve ablation, microvascular decompression (MVD), and neurostimulation techniques.
  • Examination of clinical, therapeutic, and radiological similarities between SUNHA subtypes and TN.

Main Results:

  • Lamotrigine (oral) and lidocaine (intravenous) show promise as preventive and transitional treatments, respectively.
  • Surgical options including MVD, occipital nerve stimulation, and VTA deep brain stimulation have demonstrated effectiveness in open-label studies.
  • Significant overlap exists between SUNCT, SUNA, and TN, suggesting they may represent a spectrum of the same disorder.

Conclusions:

  • SUNHA management is challenging, with limited options for acute attacks but promising results from specific preventive medications and surgical interventions.
  • The findings support a broader nosological concept, potentially classifying SUNHA with trigeminal neuralgia as a cranial neuralgia rather than a distinct entity.