A prospective comparative study and analysis of predictors of SUNA and SUNCT
Abstract
Objective
Despite the similar phenotypes, comparison between short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with autonomic features (SUNA) has hitherto not been possible due to the dearth of studies validating the phenotype of SUNA. Therefore, these 2 syndromes have been kept separate in the International Classification of Headache Disorders. The aim of this study is to characterize and compare the clinical phenotypes of large clinic-based cohorts of patients with SUNA and SUNCT.
Methods
The clinical phenotype of consecutive patients with SUNA identified from a single specialist headache center in the United Kingdom between 2007 and 2012 was studied and compared to that of patients with SUNCT.
Results
Sixty-three patients with SUNA (18 male, 28.6%) and 70 patients with SUNCT (32 male, 35.7%) were included. The demographic and clinical characteristics of patients with SUNA were similar to those of patients with SUNCT. Ptosis and rhinorrhea were predictors of SUNCT. The corresponding odds ratios (ORs) (95% confidence interval) were 3.79 (1.64–8.77, p = 0.002) and 2.46 (1.09–5.59, p = 0.031), respectively. The presence of spontaneous only attacks was a predictor for SUNA (OR 2.58 [1.10–6.05], p = 0.029).
Conclusion
No major clinical differences have emerged between SUNCT and SUNA, bar the fact that SUNCT is characterized by more prominent cranial autonomic features and triggerability. We propose that the 2 disorders be placed together in a single diagnostic category for which new diagnostic criteria are proposed.
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Information & Authors
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© 2019 American Academy of Neurology.
Publication History
Received: January 9, 2019
Accepted: May 29, 2019
Published online: August 19, 2019
Published in issue: September 17, 2019
Disclosure
G. Lambru has received speaker honoraria, funding for travel, and honoraria for participation in advisory boards sponsored by Allergan and Novartis. He has received speaker honoraria and funding for travel from electroCore, Nevro Corp, and Autonomic Technologies. K. Rantell and A. Levy report no disclosures relevant to the manuscript. M. Matharu serves on the advisory board for Allergan, St. Jude Medical, and Medtronic and has received payment for the development of educational presentations from Allergan, Merck Sharpe and Dohme Ltd, Medtronic, and electroCore. Go to Neurology.org/N for full disclosures.
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No targeted funding reported.
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- Primary headaches are a continuum driven by a common process, Discover Medicine, 1, 1, (2024).https://doi.org/10.1007/s44337-024-00068-w
- Epidemiology and clinical features of short-lasting unilateral neuralgiform headache attacks: A systematic review and meta-analysis, Cephalalgia, 44, 8, (2024).https://doi.org/10.1177/03331024241271976
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- Lacrimal Neuralgia: A Case Report and Comprehensive Review of the Literature, Current Pain and Headache Reports, 28, 9, (929-939), (2024).https://doi.org/10.1007/s11916-024-01250-6
- SUNCT, SUNA and short-lasting unilateral neuralgiform headache attacks: Debates and an update, Cephalalgia, 44, 2, (2024).https://doi.org/10.1177/03331024241232256
- A Retrospective Comparative Study in Patients with SUNA and SUNCT, Annals of Indian Academy of Neurology, 26, 5, (672-677), (2023).https://doi.org/10.4103/aian.aian_502_23
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- Recent Advances and Updates in Trigeminal Autonomic Cephalalgias, Seminars in Neurology, 42, 04, (474-478), (2022).https://doi.org/10.1055/s-0042-1758043
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