Predictors of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) include ptosis, ipsilateral rhinorrhea, and spontaneous-only attacks, study results published in Neurology suggests.

Consecutive patients with SUNA (n=63) or SUNCT (n=70) from a single specialist headache center in the United Kingdom were included in the study. Following diagnosis, patients completed a comprehensive standardized, semi-structured questionnaire that assessed pain severity and cranial autonomic features.

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Patients also kept a headache diary for ≥2 weeks between each clinic visit. Univariate and multivariable analyses were performed to assess the predictive value of age at onset, sex, side of pain, site of pain, quality of pain, duration of attack, number of attacks per day, cranial autonomic symptoms, behavior, type of attack, and headache pattern for SUNA and SUNCT.

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A greater percentage of patients with SUNA had a mild or moderate degree of lacrimation vs patients with SUNCT (51.2% vs 15.7%, respectively; P <.001). No differences were found between the 2 patient groups with regard to the laterality of attacks, site of attacks, severity or quality of pain, or duration and profile of attacks.

Predictors of SUNCT in the multivariable analysis were ptosis (odds ratio [OR], 3.79; 95% CI, 1.64-8.77; P =.002) and ipsilateral rhinorrhea (OR, 2.46; 95% CI, 1.09-5.59; P =.031). For SUNA, the predictor included the presence of spontaneous-only attacks (OR, 2.58; 95% CI, 1.10-6.05; P =.029).

Study limitations included a potential referral bias as well as the inclusion of patients from a single center.

“SUNCT and SUNA could be considered a single clinical entity under the name SUNA,” the researchers wrote, “a term that highlights the occurrence of a broad array of cranial autonomic features besides conjunctival injection and lacrimation.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Lambru G, Rantell K, Levy A, Matharu MS. A prospective comparative study and analysis of predictors of SUNA and SUNCT. Neurology. 2019;93(12):e1127-e1137.