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IHS Diagnosis ICD-10
3.3 Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) G44.08  

Description:

SUNCT

This syndrome is characterised by short-lasting attacks of unilateral pain that are much briefer than those seen in any other TAC and very often accompanied by prominent lacrimation and redness of the ipsilateral eye.

Diagnostic criteria:

  1. At least 20 attacks fulfilling criteria B-D
  2. Attacks of unilateral orbital, supraorbital or temporal stabbing or pulsating pain lasting 5-240 seconds
  3. Pain is accompanied by ipsilateral conjunctival injection and lacrimation
  4. Attacks occur with a frequency from 3 to 200 per day
  5. Not attributed to another disorder1

Note:

  1. History and physical and neurological examinations do not suggest any of the disorders listed in groups 5-12, or history and/or physical and/or neurological examinations do suggest such disorder but it is ruled out by appropriate investigations, or such disorder is present but attacks do not occur for the first time in close temporal relation to the disorder.

Comment:

This syndrome was described after the publication of the first edition of The International Classification of Headache Disorders and has become well recognised in the last decade.

Patients may be seen with only one of conjunctival injection or tearing, or other cranial autonomic symptoms such as nasal congestion, rhinorrhoea or eyelid oedema may be seen. 3.3 SUNCT may be a subform of A3.3 Short-lasting Unilateral Neuralgiform headache attacks with cranial Autonomic symptoms (SUNA), described in the appendix.

The literature suggests that the most common mimics of 3.3 SUNCT are lesions in the posterior fossa or involving the pituitary gland.

SUNCT with coexistent trigeminal neuralgia: Patients have been described in whom there is an overlap between 3.3 SUNCT and 13.1 Trigeminal neuralgia. Such patients should receive both diagnoses. This differentiation is clinically difficult.

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