Short-lasting unilateral neuralgiform headache attacks: Treatment
- Manjit S Matharu, MD
Manjit S Matharu, MD
- Consultant Neurologist
- The National Hospital for Neurology and Neurosurgery, London
- Anna S Cohen, MD
Anna S Cohen, MD
- Consultant Neurologist
- Royal Free Hospital, London
The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders characterized by unilateral trigeminal distribution pain that occurs in association with ipsilateral cranial autonomic features [1,2]. The TACs include cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua . There are two subtypes of short-lasting unilateral neuralgiform headache attacks :
●Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)
●Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA)
Although SUNCT and SUNA were once considered to be refractory to therapy, beneficial responses with several categories of medications have been reported in small numbers of patients. However, the evidence consists mainly of case reports and small case series.
This topic will review the treatment and prognosis of SUNCT and SUNA. The clinical features and diagnosis of these headaches are reviewed elsewhere. (See "Short-lasting unilateral neuralgiform headache attacks: Clinical features and diagnosis".)
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- ACUTE MEDICATIONS
- - Administration and side effects
- PREVENTIVE MEDICATIONS
- - Dose and side effects
- - Dose and side effects
- - Dose and side effects
- Treatment choice
- Greater occipital nerve blockade and stimulation
- Other local blockades
- Trigeminal microvascular decompression
- Destructive trigeminal nerve procedures
- Deep brain stimulation
- SUMMARY AND RECOMMENDATIONS