SUNCT and SUNA: an Update and Review

Area of Science:

• Neurology
• Headache Medicine
• Neuroscience

Background:

• Short-lasting unilateral neuralgiform headache attacks (SUNCT) and short-lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA), collectively termed SUNHA, are rare primary headache disorders.
• Understanding the pathophysiology and treatment of SUNHA is crucial for managing patients with these debilitating conditions.

Purpose of the Study:

• To provide an updated review of the clinical features, diagnosis, pathogenesis, epidemiology, and treatment of SUNCT and SUNA.
• To highlight recent advancements in understanding the pathophysiology and therapeutic options for SUNHA.

Main Methods:

• Review of recent case reports and literature concerning SUNCT and SUNA.
• Discussion of the trigeminohypothalamic pathway's role in SUNHA pathophysiology.
• Analysis of current and emerging medical, procedural, and surgical treatment strategies.

Main Results:

• Recent findings suggest the trigeminohypothalamic pathway is implicated in SUNHA pathophysiology, supported by cases of secondary SUNCT/SUNA from medullary infarcts.
• Medical therapy for SUNHA has seen limited changes, but surgical interventions, particularly deep brain stimulation, show efficacy in refractory cases.
• The review details the pathophysiology of pain and autonomic symptoms and outlines various treatment modalities.

Conclusions:

• The trigeminohypothalamic pathway is a key area of focus for understanding SUNHA.
• Deep brain stimulation represents a significant advancement in surgical treatment for refractory SUNCT and SUNA.
• Continued research into secondary causes and refined treatment approaches is essential for managing SUNHA.