Short-lasting unilateral neuralgiform headache attacks: case reports and review

BackgroundShort-lasting unilateral neuralgiform headache attacks are the rarest type of trigeminal-autonomic cephalalgias (TACs), typically classified into two subtypes: SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) and SUNA (with cranial autonomic symptoms). These disorders are characterized by brief, unilateral headache attacks accompanied by cranial parasympathetic symptoms and can be difficult to diagnose and manage in clinical practice.ObjectiveTo present two clinical cases of SUNCT and provide a comprehensive review of the current diagnostic criteria, pathophysiology, and treatment options, while distinguishing SUNCT/SUNA from other headache syndromes.MethodsWe describe two patients diagnosed with SUNCT at our outpatient headache clinic. A literature review was conducted focusing on clinical features, diagnostic criteria from the International Classification of Headache Disorders (ICHD-3), proposed pathophysiological mechanisms, and available treatment strategies.ResultsBoth patients presented with multiple daily, short-lasting, unilateral headache attacks accompanied by cranial autonomic symptoms. Diagnostic workup ruled out secondary causes. The clinical presentation aligned with SUNCT criteria as defined in ICHD-3. Treatment approaches varied and included pharmacological interventions with partial symptom relief. The review highlights the challenges in differentiating SUNCT/SUNA from other headache disorders such as trigeminal neuralgia and cluster headache.ConclusionAccurate recognition of SUNCT/SUNA is essential for appropriate management, as misdiagnosis is common due to symptom overlap with other headache syndromes. Improved awareness and understanding of these rare conditions can lead to better diagnosis, targeted treatment, and patient outcomes.