Abstract Details

Title Accuracy of Pre-Headache Clinic SUNCT Diagnosis: A Cautionary Tale

Topic Headache

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-018

Objective

- The objectives of this study were to describe the population of patients diagnosed with Short Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) prior to Headache Clinic referral and to determine whether lack of familiarity with diagnostic criteria led to delayed diagnosis or misdiagnosis of the headache type.

Background SUNCT is one of the rarest primary headache disorders and the least common trigeminal autonomic cephalalgia (TAC), with a prevalence of 1-9/100,000. Patients usually present with excruciating unilateral headaches and autonomic symptoms lasting for only a second to ten minutes, twenty or more times per day. Unfamiliarity with rare conditions can impede diagnostic accuracy. No published studies have examined accuracy of SUNCT diagnosis prior to Headache Clinic evaluation.

Design/Methods This retrospective analysis used the Leaf research data base to analyze SUNCT patients (ICD-10 G44.059) seen at University of Washington Medical Center. Their individual charts were reviewed.

Results There were 21 patients diagnosed with SUNCT. Only three met all ICHD-3 criteria for SUNCT. Only one patient received an accurate SUNCT diagnosis prior to evaluation in the Headache Clinic. Five patients met some criteria for SUNCT but diagnostic uncertainty remained due to overlap with another syndrome or unclear documentation. Of the remaining 13, duration was inconsistent with SUNCT in 11/13, frequency in 8/13, and 4/13 lacked autonomic features. Patients with inaccurate diagnoses had been referred from primary care, neurosurgery, ophthalmology, and general or non-headache neurology subspecialties.

Conclusions SUNCT remains a rare and widely misunderstood diagnosis. Subspecialty care was required to identify this headache type accurately and the headache clinic has identified only three patients over four years with this condition. Additionally, given the confusion around SUNCT diagnosis, there are likely additional SUNCT patients who have gone undetected. As misdiagnosis of headache subtype impedes effective treatment, further education and awareness of ICHD-3 criteria are necessary.

Authors/Disclosures
Jennifer Wax, MD (Confluence Health) PRESENTER	No disclosure on file
Anusha Mannava, MD	No disclosure on file
Jenna Kanter, MD	No disclosure on file
Daniel Krashin, MD (Seattle VA)	Dr. Krashin has nothing to disclose.
Natalia Murinova, MD, FAAN (University Of Washington)	Dr. Murinova has nothing to disclose.

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