Clinical characteristics, neurovascular compression, and treatment outcomes in SUNCT and SUNA: A contemporary Japanese consecutive case series.
Microvascular decompression achieved complete, sustained remission in most refractory SUNHA patients.
Clinical characteristics, neurovascular compression, and treatment outcomes in SUNCT and SUNA: A contemporary Japanese consecutive case series.
SUNHA, comprising short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and those with cranial autonomic symptoms (SUNA), is a rare trigeminal autonomic cephalalgia disorder.
This study aimed to characterize the contemporary clinical phenotype of short-lasting unilateral neuralgiform headache attacks (SUNHA) in Japan, evaluate the prevalence and clinical relevance of neurovascular compression (neurovascular compression), and assess real-world medical and surgical treatment outcomes.
We conducted a retrospective consecutive case series of 28 patients with SUNHA (14 SUNCT and 14 SUNA) who were evaluated at a tertiary headache center in Japan between 2011 and 2024.
SUNHA accounted for 0.2% of all patients with headache evaluated in this study.
The mean age at onset was 53.1 ± 20.9 years, with 17 male and 11 female patients.
No statistically significant differences were detected between SUNCT and SUNA with respect to attack duration, frequency, triggers, or treatment responsiveness.
Seven of 28 patients (7/28, 25%; 95% CI: 12.7%-43.4%) met criteria for refractory SUNHA, and all refractory cases (7/7, 100%; 95% CI: 64.6%-100%) demonstrated neurovascular compression.
In this contemporary Japanese SUNHA cohort, no statistically significant clinical differences were detected between SUNCT and SUNA. neurovascular compression was relatively common and appeared to be associated with medical refractoriness.
In carefully selected patients with refractory SUNHA and convincing neurovascular compression, microvascular decompression may provide durable clinical benefit.