Lauren Levi DMD MS

Trigeminal autonomic cephalalgias are primary headache disorders that are accompanied by autonomic symptoms (eye tearing, eye redness, nasal congestion, ear fullness). There are 5 main types of trigeminal autonomic cephalalgias with cluster headache being the most common and well known. 

 

SUNCT/SUNA

Short-lasting unilateral neuralgiform headache attacks (SUNCT and SUNA) are rare primary headache conditions. Both belong to the group of disorders known as trigeminal autonomic cephalalgias (TACs), which are characterized by brief but extremely painful headaches and associated autonomic symptoms (such as tearing or nasal congestion).

 

What Are SUNCT and SUNA?

These headaches occur on one side of the head, typically around the eye, temple, or forehead. The pain is often intense and debilitating, but unlike other headache types, the attacks are very brief, lasting from a few seconds to several minutes.

 

Despite the short duration, these headaches can occur multiple times a day, severely impacting daily life.

 

The Difference Between SUNCT and SUNA

While SUNCT and SUNA are closely related, they are distinguished by the specific symptoms that accompany the headache pain:

• SUNCT (Short-lasting Unilateral Neuralgiform Headache with Conjunctival Injection and Tearing): This type includes eye redness (conjunctival injection) and tearing on the same side as the headache.

• SUNA (Short-lasting Unilateral Neuralgiform Headache with Autonomic Symptoms): SUNA may also involve nasal congestion, facial sweating, flushing, or eyelid drooping (ptosis), but it may not include both eye redness and tearing.

 

In both conditions, the autonomic symptoms always appear on the same side as the headache.

 

Treatment Options for SUNCT and SUNA

Although SUNCT and SUNA are rare, effective treatments are available to help manage the frequency and intensity of attacks. Treatment options often include:

• Medications: Anticonvulsants like lamotrigine or gabapentin are commonly used to reduce the number of headache attacks.

• Nerve blocks: In some cases, targeted nerve blocks may provide relief.

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PAROXYSMAL HEMICRANIA

Paroxysmal hemicrania is a primary headache disorder that features frequent, intense headache episodes occurring predominantly on one side of the head. These episodes are short but severe.

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Key Features of Paroxysmal Hemicrania:

• Headache Characteristics: Patients experience multiple headache attacks daily, with each attack lasting between 2 to 30 minutes. Despite the brevity, the pain is intense and typically localized to one side of the head.

• Associated Symptoms: These headaches are accompanied by autonomic symptoms on the same side of the pain, including:

  • Runny nose or nasal congestion

  • Forehead sweating

  • Eye tearing (lachrymation)

  • Eye redness (conjunctival injection)

  • Drooping of the eyelid (ptosis)​

 

Impact on Daily Life

Living with paroxysmal hemicrania can be challenging due to the frequency and intensity of the headache attacks. The condition can disrupt daily activities, work, and overall quality of life. Understanding and managing these symptoms is crucial for maintaining well-being.

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Diagnosis and Treatment

Diagnosing paroxysmal hemicrania involves a thorough evaluation of the headache pattern and associated symptoms. Imaging and other diagnostic tests may be utilized to exclude other potential conditions.

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Treatment Options:

• Medication: Indomethacin is often effective in managing symptoms. Other medications or treatments may be recommended based on individual needs.

• Lifestyle Adjustments: Making certain lifestyle changes can help manage symptoms. This might include stress management techniques and avoiding known triggers.

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Why It Matters

Recognizing and treating paroxysmal hemicrania is essential for reducing the frequency and severity of attacks and improving overall quality of life. If you experience symptoms that might be consistent with paroxysmal hemicrania, consult with a specialist for a comprehensive evaluation and personalized treatment plan.

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Have Questions or Need Help?

If you suspect you have paroxysmal hemicrania or need more information, don’t hesitate to reach out to our practice. Our team of experts is here to provide support and guide you towards effective management of your condition.

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CLUSTER HEADACHE

Cluster headaches are a debilitating form of headache disorder characterized by excruciating, piercing pain localized unilaterally, often around the temple or behind the eye. These headaches are aptly named due to their tendency to occur in clusters, with multiple attacks happening over days, weeks, or even months, followed by periods of remission. Dr. Levi specializes in recognizing and effectively managing cluster headaches to alleviate suffering and improve quality of life.

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Symptoms:

The hallmark symptom of cluster headaches is intense, stabbing pain that can be described as a "hot poker" or a "drilling" sensation. This pain typically peaks in intensity within minutes and can last anywhere from 30 minutes to three hours. Individuals experiencing cluster headaches often report agitation, restlessness, and a sense of impending doom during an attack.

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Associated Symptoms:

Cluster headaches are often accompanied by various autonomic symptoms on the affected side of the head, such as:

• Runny Nose (Rhinorrhea): Excessive nasal discharge is a common feature during cluster headache attacks, often leading to congestion and discomfort.

• Tearing (Lacrimation): Uncontrollable tearing of the eye on the affected side can occur concurrently with the headache.

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Diagnosis and Treatment:

Diagnosing cluster headaches requires a thorough evaluation by a healthcare professional experienced in headache disorders. Our practice offers comprehensive assessments to accurately diagnose cluster headaches and differentiate them from other headache disorders or orofacial pain conditions.

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Treatment strategies for cluster headaches may include:

• Acute Management: Utilizing abortive medications to alleviate pain and reduce the duration of cluster headache attacks.

• Preventive Therapies: Implementing long-term preventive measures to reduce the frequency and severity of cluster headache episodes.

• Lifestyle Modifications: Identifying and addressing triggers that may precipitate cluster headaches, such as certain foods, stressors, or sleep disturbances.

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Comprehensive Care:

At our practice, we understand the profound impact that cluster headaches can have on daily functioning and overall well-being. We are dedicated to providing compassionate care and personalized treatment plans tailored to each patient's unique needs. Through a multidisciplinary approach, we strive to empower individuals to effectively manage their cluster headaches and reclaim control over their lives.

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HEMICRANIA CONTINUA

Characterized by a continuous, one-sided headache persisting for over three months, this condition is often accompanied by autonomic symptoms, including eye tearing, eye redness, and nasal congestion. Additionally, patients may experience restlessness or agitation, akin to symptoms observed in cluster headaches.

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Diagnostic Complexity and Similarities:

Diagnosing hemicrania continua requires a nuanced understanding of its clinical presentation, as it shares several features with other primary headache disorders, notably chronic migraine and cluster headache. The overlap in symptoms often complicates the diagnostic process, necessitating thorough evaluation and differential diagnosis.

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Distinguishing Features:

Hemicrania continua bears similarities to chronic migraine making diagnosis challenging. Like chronic migraine, hemicrania continua manifests as a continuous headache, with fluctuations in intensity. Hemicrania continua is usually sidelocked meaning that it occurs on one side of the head and is often accompanied by autonomic symptoms. Response to indomethacin is considered diagnostic of hemicrania continua but there are individuals who do not respond to this medication or cannot tolerate it.

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Treatment Approaches:

Managing hemicrania continua requires a multifaceted treatment approach tailored to the individual needs of each patient. The primary pharmacological intervention involves the use of indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), which has demonstrated efficacy in alleviating symptoms in the majority of cases. However, some patients may exhibit intolerance or contraindications to indomethacin, necessitating alternative treatment strategies.

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In cases where indomethacin is ineffective or poorly tolerated, various treatments are available including medications, such as topiramate, celecoxib, or gabapentin, and neuromodulation.

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Comprehensive Care:

Our multidisciplinary approach emphasizes not only symptom management but also patient education, support, and empowerment. By collaborating with a multidisciplinary team of specialists, we strive to provide comprehensive care tailored to address the unique needs of each individual.

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If you suffer from headaches, we can help 

Headache treatments may include medication, behavioral modifications, botox, muscle injections, exercises, and dietary changes. Dr. Levi has extensive training and experience treating headache.