3.3 Short-lasting unilateral neuralgiform headache attacks

Description:

Attacks of moderate or severe, strictly unilateral head pain lasting seconds to minutes, occurring at least once a day and usually associated with prominent lacrimation and redness of the ipsilateral eye.

Diagnostic criteria:
  1. At least 20 attacks fulfilling criteria B–D
  2. Moderate or severe unilateral head pain, with orbital, supraorbital, temporal and/or other trigeminal distribution, lasting for 1–600 seconds and occurring as single stabs, series of stabs or in a saw-tooth pattern
  3. At least one of the following five cranial autonomic symptoms or signs, ipsilateral to the pain:
    1. conjunctival injection and/or lacrimation
    2. nasal congestion and/or rhinorrhoea
    3. eyelid oedema
    4. forehead and facial sweating
    5. miosis and/or ptosis
  4. Occurring with a frequency of at least one a day1
  5. Not better accounted for by another ICHD-3 diagnosis.
Note:

During part, but less than half, of the active time-course of 3.3 Short-lasting unilateral neuralgiform headache attacks, attacks may be less frequent.

Comments:

Longer-duration attacks are characterized by multiple stabs or a saw-tooth pain pattern.

Two subtypes of 3.3 Short-lasting unilateral neuralgiform headache attacks are recognized: 3.3.1 Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and 3.3.2 Short lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). 3.3.1 SUNCT may be a subform of 3.3.2 SUNA, although this requires further study. Meanwhile, each is classified as a separate subtype, described below.

3.3.1 SUNCT and 3.3.2 SUNA can usually be triggered without a refractory period. This is in contrast to 13.1.1 Trigeminal neuralgia, which usually has a refractory period after each attack.