Pearls & Oy-sters: Late-Onset Presumed SUNA in a 91-Year-Old Woman With Headache.

Abstract

Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) is a rare form of headache classified under trigeminal autonomic cephalalgias. It typically occurs in middle adulthood, most commonly between ages 30 and 60 years; however, a case of an 88-year-old patient has been reported. Here, we present a 91-year-old woman with a 2-month history of headaches with features suggestive of SUNA. However, the criterion of experiencing a second bout 3 months apart was not satisfied, rendering the diagnosis presumptive. Comprehensive investigations, including MRI and MRA of the brain, ruled out secondary causes such as vascular or structural abnormalities. The patient was successfully treated with pregabalin, achieving full remission of attacks within 2 weeks of treatment initiation. Recognizing SUNA in the older population is crucial because this headache disorder can present later in life. Key diagnostic features include cranial autonomic symptoms, brief attack duration, high attack frequency, and stabbing pain quality, enabling prompt diagnosis and treatment to improve patients' quality of life.