To systematically review and analyze the effectiveness of treatment options, clinical outcomes, and brain magnetic resonance imaging (MRI) findings for short-lasting neuralgiform headache attacks with cranial autonomic symptoms (SUNA), and to identify gaps in the current evidence base.

Trigeminal autonomic cephalalgias (TACs), including SUNA, are rare but severely disabling headache disorders. SUNA is particularly challenging due to its intense, brief pain episodes and associated autonomic symptoms like tearing or nasal congestion. The pathophysiology of SUNA remains poorly understood, and treatment options are inconsistent, further complicated by limited research and disparities in healthcare access. Understanding the effectiveness of available treatments and exploring neuroimaging findings are essential steps toward improving patient outcomes.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was performed across multiple databases. Data from 20 studies were analyzed, focusing on treatment efficacy, patient demographics, and MRI findings. Meta-analyses were conducted on treatment effectiveness, and bias was assessed using the Newcastle-Ottawa Scale.

Among 267 patients, the most commonly used treatments were lamotrigine (37.07%) and greater occipital nerve (GON) block (16.85%), showing effectiveness in over 50% of cases. Heterogeneity in lamotrigine effectiveness was high (Cochran’s Q = 63.10, p-value < 0.0001, α = 0.05). Lidocaine was effective for acute attacks (> 80%). Brain MRIs were mostly unremarkable, with some evidence suggesting neurovascular involvement.

Lamotrigine and GON block are effective for SUNA, though treatment responses vary widely. MRI findings often lack abnormalities, suggesting a need for further research into the pathophysiology of SUNA. Larger, high-quality studies are needed to establish standardized treatment protocols and improve patient outcomes.