(Severe brief unilateral nevralgic headache with conjunctival injection)

Acronym for Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing.

Prevalence around 1/50,000 with a slight male predominance. Primary headache in the territory of the trigeminal nerve.  The onset is generally around the age of 50 years but pediatric cases have been reported.

Clinical picture: attacks of acute throbbing ("blow of dagger) pain that are strictly unilateral affecting most often the ophthalmic branch of the trigeminal nerve (periorbital). These crises are very short (5-240 sec) but may be repeated many times (3 to 200 per day). They are accompanied by ipsilateral conjunctival injection and tearing. Nasal congestion and rhinorrhea are common. In case of SUNA (Short-lasting Unilateral Neuralgiform headache with Autonomic symptoms), either conjunctival injection or tearing is present, never both together. Crises rarely occur at night.

Possible triggering factors: chewing, cold wind on the face, talk, touching the face, bright light or sudden change in the position of the neck...

Possible treatments (often of limited effectiveness): lamotrigine, NSAIDs, carbamazepine, gabapentin, sumatripan, occipital nerve stimulation, trigeminal nerve decompression, hypothalamic stimulation.

Anesthetic implications:

avoid the triggering agent(s) and adjust the usual treatment.

References : 

-         Evers S, Afra J, Frese A, Goadsby PJ et al. 
Cluster headache and other trigemino-autonomic cephalgias. Chapter 11 
In  European Handbook of Neurological Management. 2nd ed, by NE Gilhus, MP Barnes & M Brainin. Blackwell 2011, p179-90.

Updated: September 2018