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.

Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT) syndrome is a rare trigeminal autonomic cephalalgia characterised by brief, unilateral, severe pain episodes and autonomic symptoms. Secondary SUNCT has been associated with brainstem lesions, implicating the trigeminocervical complex in its pathogenesis. We describe a man in his 40s with secondary SUNCT and occipital neuralgia following a right dorsolateral medullary infarction. He presented with right facial numbness and burning pain lasting about a minute, occurring over four times daily, triggered by touch. Examination revealed dacryorrhoea, rhinorrhoea and ipsilateral facial oedema. Brain MRI confirmed subacute medullary infarction, establishing secondary SUNCT. Subsequently, he developed intermittent electrical pain in the right posterior head, neck, shoulder and arm, diagnosed as occipital neuralgia, which responded to gabapentin. This case highlights the importance of high-resolution neuroimaging and follow-up in atypical headache presentations to identify structural lesions and optimise management.

Rare episodic cluster headache mimicking SUNCT syndrome presents a unique clinical challenge due to overlapping trigeminal autonomic features and limited therapeutic efficacy of conventional interventions. Recent innovations in advanced biomaterials, such as poly(L-lactic acid) and PVDF-based piezoelectric scaffolds integrated with decellularized extracellular matrix, offer biocompatible platforms for trigeminal nerve repair and inflammation modulation. Virtual reality (VR) technologies, through immersive pain-modulation environments, enhance neuroplasticity and empower patients in real-time symptom control. Artificial intelligence (AI) algorithms, incorporating multi-omic and wearable sensor data, enable personalized trigger profiling, predictive prevention, and early attack forecasting. CRISPR-based gene-editing strategies targeting pain-modulating genes, such as TACR1, have demonstrated potential in preclinical models for refractory headache management. Integrating these multidisciplinary innovations into clinical frameworks may pave the way for precision pain medicine, improved patient self-management, and enhanced long-term outcomes for those suffering from this debilitating headache disorder.

This analysis aims to evaluate the sustained effectiveness of trigeminal microvascular decompression (MVD) in patients with medically refractory short-lasting unilateral neuralgiform headache attacks (SUNHA) who demonstrate trigeminal neurovascular conflict (NVC) ipsilateral to the painful side. This is a retrospective single-center analysis of prospectively collected data conducted between September 2012 and March 2025 to investigate the efficacy and safety of trigeminal MVD in consecutive refractory chronic SUNHA patients suitable for surgery. All patients underwent a magnetic resonance imaging with specific trigeminal sequences before surgery. The 5-point Barrow Neurological Institute (BNI) pain intensity score was used to quantify the response to surgery. Patients with a BNI of 1-2 at the final postsurgery follow-up were considered responders. The study group consisted of 19 SUNHA patients (n = 7 female), with a mean age of 58 (±12, range 35-81), refractory to medical therapy (BNI score = 5), who underwent trigeminal MVD. Of the 18 patients included in the analysis, trigeminal NVC with morphological changes was found in 13 patients (72.2%). Postoperatively, 16 patients (89.0%) were responders. Two patients had a BNI score of 3, reflecting a partial improvement (11.1%). The mean postsurgery follow-up was 54.3 months (±36.7, range 2-163 months). At the final follow-up, 13 patients remained responders (72.2%). One patient reported transient postoperative dizziness, and 1 patient reported pain in the incision site. Trigeminal MVD may be a safe and effective treatment modality for those patients with medically refractory SUNHA with magnetic resonance imaging evidence of trigeminal NVC with morphological changes.

The aim of this review is to summarize the data available in the literature on the causes of headache in patients with acromegaly, as well as on the effect of various methods of acromegaly treatment on headache. Publications were searched in the PubMed database using the keywords «Headache in patients with acromegaly», «Headache in patients with pituitary adenomas», «Tension-type headache», «Migraine». Headache in patients with pituitary adenomas secreting somatotropic hormone (STH) is not uncommon: according to various authors, cephalgic syndrome occurs in 30-70% of patients with acromegaly and can worsen their quality of life, along with other factors, up to disability. By the nature of development, headache with acromegaly is classified into primary (migraine, tension headache, trigeminal autonomic cephalgia, for example, SUNCT syndrome and cluster headaches), and can also be caused by various causes directly related to the tumor. All this requires differential diagnosis. The factors causing headaches in somatotropinomas have not yet been well studied and require further research. These include the mass effect of the tumor, hormonal hypersecretion, pathology of the temporomandibular joint, sodium and fluid retention in the body, psychological factors, etc. The authors evaluated the effect on headache of various methods of acromegaly treatment: transnasal transsphenoidal adenomectomy, radiation therapy and drug therapy with somatostatin analogues, dopamine agonists and growth hormone receptor antagonist. However, even when normal levels of STH and insulin-like growth factor 1 (IGF-1) are reached, cephalgic syndrome may persist, therefore patients should be warned about this in advance and referred to a cephalgologist to select adequate headache therapy. Целью данного обзора является обобщение имеющихся в литературе данных о причинах головной боли, возникающей у пациентов с акромегалией, а также о влиянии различных методов лечения акромегалии на головную боль. Поиск публикаций производился в базе данных PubMed по ключевым словам: «Headache in patients with acromegaly», «Headache in patients with pituitary adenomas», «Tension-type headache», «Migraine». Головная боль у пациентов с аденомами гипофиза, секретирующими соматотропный гормон (СТГ), — нередкое явление: по данным разных авторов, цефалгический синдром встречается у 30–70% больных акромегалией и может ухудшать качество их жизни наряду с другими факторами, вплоть до инвалидизации. По характеру развития головная боль при акромегалии классифицируется на первичную (мигрень, головная боль напряжения, тригеминальные вегетативные цефалгии, например, SUNCT-синдром и кластерные головные боли), а также может вторично вызываться различными причинами, связанными непосредственно с опухолью. Все это требует дифференциальной диагностики. Факторы, вызывающие головные боли при соматотропиномах, пока недостаточно хорошо изучены и требуют дальнейших исследований. К ним относят масс-эффект опухоли, гормональную гиперсекрецию, патологию височно-нижнечелюстного сустава, задержку в организме натрия и жидкости, психологические факторы и др. Авторами проводилась оценка влияния на головную боль различных методов лечения акромегалии: трансназальной транссфеноидальной аденомэктомии, лучевой терапии и медикаментозной терапии аналогами соматостатина, агонистами дофамина и антагонистом рецепторов гормона роста. Однако даже при достижении нормальных уровней СТГ и инсулиноподобного фактора роста 1 (ИФР-1) цефалгический синдром может сохраняться, поэтому пациенты должны быть об этом предупреждены и направлены к цефалгологу для подбора адекватной терапии головной боли.