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Unbearable pain: How does SUNCT affect daily life?
Transient unilateral neuralgic headache with conjunctival injection and tearing (SUNCT syndrome) is a rare headache disorder belonging to trigeminal autonomic cephalalgias (TACs). Patients typically report experiencing a constant burning, stabbing, or electric-like severe headache, particularly around the eyes. These symptoms usually affect only one side of the body and can cause serious disruption to daily life.
Each episode lasts from five seconds to six minutes and can occur up to 200 times a day.
The induction of TACs is associated with the activation of the trigeminal autonomic nervous system. According to medical literature as of 2015, only about 50 cases have been described in detail. Symptoms generally begin to appear around age 50, and although most patients are men over the age of 50, SUNCT can also occur in other age groups, even infants.
Symptoms and Effects
SUNCT patients often describe their headache attacks as extremely painful. These episodes often severely interfere with their daily activities, but most people do not require hospitalization.
The average number of seizures per day is about 60, ranging from 3 to 200.
SUNCT attacks can be divided into several types, including single stabbing pain, combination of stabbing pain, and sawtooth type attacks. Symptoms usually appear in the eye sockets, forehead and temporal areas, and occasionally appear behind the eye sockets, the top of the head and other parts, even involving the teeth, neck and ears. An even smaller proportion (less than 2%) of attacks occur at night.
Symptoms
SUNCT is often accompanied by some intracranial autonomic symptoms, such as tearing, ipsilateral ptosis (i.e. drooping eyelid on the side of the attack), eyelid edema, nasal congestion and conjunctival injection. These autonomic symptoms vary depending on the distribution of the trigeminal nerve affected.
Sometimes, when there are fewer associated autonomic symptoms, patients may be diagnosed with transient unilateral neuralgic headache (SUNA), which accounts for less than 20% of all reported cases.
Triggers of an attack
Although SUNCT usually occurs spontaneously, some everyday stimuli such as touching the face or scalp, bathing, eating, talking, and coughing may trigger an attack. Changes in lighting and surroundings can also be irritants. Some patients may experience seasonal attacks, particularly in the spring and fall.
Diagnosis and treatment
The diagnosis of SUNCT needs to be differentiated from other headache types such as cluster headache. Its temporal duration is characterized by shorter attack duration and higher number of attacks. The medical community has not yet found an effective cure, and patients usually try anti-epileptic drugs such as lamotrigine, pregabalin, etc. to improve symptoms.
Currently, the treatment of SUNCT needs to be further standardized. Common headache medications such as nonsteroidal anti-inflammatory drugs are not effective for SUNCT.
Future Directions
While there is currently no permanent cure, some research points to possible treatments, such as the use of drug combinations and psychotropic medications, and even research into the use of certain hallucinogenic drugs.
The effects of SUNCT can severely impair a patient's quality of life and greater attention and resources are needed to understand and research this disease so that better support and treatment options can be provided. New cases are reported every year, and patients' experiences bring a deeper understanding of this disease. How can we better help these patients and reduce their pain?
