Quiz Form

Question Date: 21/07/2023

Question: A 65 year old man presents with bouts of sharp stabbing pain around right eye and temple since several years. Attacks last for a minute, and recur 50 times a day. The pain causes redness and watering from the eye and a runny nose. Pain is triggered by washing the face and brushing the teeth. An MRI showed vascular loop in conflict with right trigeminal nerve<br><br>What is the likely diagnosis?

Options:

• Trigeminal Neuralgia
• Short lasting unilateral neuralgiform headache attack (SUNHA)
• Giant cell arteritis
• Idiopathic stabbing headache

Correct Answer: Short lasting unilateral neuralgiform headache attack (SUNHA)

Explaination: Short lasting unilateral neuralgiform headache attack (SUNHA) consists of two types. Short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and Short lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). In SUNA lacrimation/redness may be absent<br><br>Cranial autonomic features (Lacrimation, conjunctival injection, nasal congestion, facial sweating/flushing, eyelid edema, miosis and ptosis or ear fullness) differentiate it from trigeminal neuralgia. Triggers such as touching, chewing and brushing teeth are seen in SUNHA and trigeminal neuralgia, but there is no refractory period in SUNHA. Vascular loop is not uncommonly seen in SUNHA and it may respond to carbamazepine, although lamotrigine is the drug of choice. The long duration of headache and autonomic features make Giant cell arteritis and idiopathic stabbing headache unlikely.

Reference: Nahas SJ. Cluster Headache and Other Trigeminal autonomic Cephalalgias. Continuum 2021;271(3 Headache):633-651.