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SUNCT, SUNA and trigeminal neuralgia: different disorders or variants of the same disorder?

Lambru, Giorgioa; Matharu, Manjit S.a,b

Current Opinion in Neurology: June 2014 - Volume 27 - Issue 3 - p 325–331
doi: 10.1097/WCO.0000000000000090
HEADACHE: Edited by Manjit Matharu

Purpose of review Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), short-lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA) and trigeminal neuralgia are considered different disorders, thus grouped in separate sections of the International Classification of Headache Disorders 3 beta. However, the clinical, radiological and therapeutic overlap between SUNCT, SUNA, and trigeminal neuralgia has challenged this traditional view. This review summarizes the available clinical and pathophysiological evidence on whether SUNCT, SUNA and trigeminal neuralgia should be considered separate entities or variants of the same disorder.

Recent findings Data on the clinical phenotype and effective management strategies in SUNCT and SUNA syndromes have shown striking similarities with trigeminal neuralgia. Moreover, studies exploring radiological findings supported the hypothesis of common aetiological and pathophysiological basis between SUNCT/SUNA and trigeminal neuralgia. However, a limitation of most studies is that they have included small samples of patients and therefore any conclusions need to be drawn cautiously.

Summary Despite being considered distinct conditions, emerging clinical and radiological evidence supports a broader nosological concept of SUNCT, SUNA, and trigeminal neuralgia. These conditions may constitute a continuum of the same disorder, rather than separate clinical entities. Further evidence is required to shed light on this nosological issue, given its potential impact on clinical practice and further research studies in this area.

aHeadache Group, Institute of Neurology

bThe National Hospital for Neurology and Neurosurgery, Queen Square, London, UK

Correspondence to Dr Manjit Singh Matharu, Senior Lecturer and Honorary Consultant Neurologist, Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK. Tel: +44 2034483664; fax: +44 7092120797; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins