Comments:
The current classification for 3.3 SUNCT has some notable problems. First, the name implies that all patients must have both conjunctival injection and tearing. This is not the Subcommittee's invariable clinical experience. It is possible that 3.3 SUNCT is a subform of a broader problem of A3.3 SUNA. This proposal requires validation. Second, the pain of the attacks can be difficult to differentiate from that of 13.1 Trigeminal neuralgia affecting the ophthalmic division. One suggested distinction is the absence of a refractory period to cutaneous stimulation in A3.3 SUNA. Third, the criterion for attack frequency in 3.3 SUNCT is rather unhelpful given the breadth of variation it allows. Since attacks are usually at least daily, simplifying the frequency requirement may be more useful.
The following proposed criteria for A3.3 SUNA (as an alternative to 3.3 SUNCT) are for research purposes and need to be tested. Cranial autonomic features should be prominent to distinguish this disorder from ophthalmic division trigeminal neuralgia.
Diagnostic criteria:
- At least 20 attacks fulfilling criteria B-E
- Attacks of unilateral orbital, supraorbital or temporal stabbing or pulsating pain lasting from 2 seconds to 10 minutes
- Pain is accompanied by one of:
- conjunctival injection and/or lacrimation
- nasal congestion and/or rhinorrhoea
- eyelid oedema
- Attacks occur with a frequency of ≥1 per day for more than half of the time
- No refractory period follows attacks triggered from trigger areas
- Not attributed to another disorder
