{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:19:23Z","timestamp":1790702363667,"version":"4.1.0"},"reference-count":41,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,8]]},"abstract":"\nObject<\/jats:title>\nAutonomic symptoms can occur in association with the facial pain of trigeminal neuralgia (TN). The distinction between first division (V1) TN and trigeminal autonomic cephalgias, particularly short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), can be difficult. The goal in this study was to investigate the frequency of autonomic symptoms with TN and to determine their effect on surgical outcome.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nThe authors sent questionnaires and reviewed the records of 92 patients who underwent surgical procedures for TN to obtain visual analog scale scores for pain before and after surgery and to determine the location of the pain and the presence of autonomic symptoms.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nSixty-seven percent of patients had at least 1 autonomic symptom, and 14% had 4 or more autonomic symptoms associated with their pain. With V1 pain, the most common autonomic symptoms were conjunctival injection, ptosis, and excessive tearing. With pain involving the second division (V2), facial swelling was the most common autonomic symptom. Excessive salivation occurred most often when the pain involved the third division (V3). In patients who underwent microvascular decompression (MVD), visual analog scores for pain showed significantly greater improvement postoperatively in those who had no preoperative autonomic symptoms than in those who reported autonomic symptoms. There was also a significantly greater number of patients who were pain free postoperatively in the group without autonomic symptoms. There were 3 patients with V1 facial pain associated with conjunctival injection and tearing who, in retrospect, fulfilled all the current diagnostic criteria for SUNCT. These patients underwent MVD, during which a vessel was found to compress the trigeminal nerve. Postoperatively, the 3 patients experienced complete and long-lasting pain relief.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nThe presence of autonomic symptoms in TN correlated with a worse prognosis for pain relief after MVD. First division TN with autonomic symptoms can present identically to SUNCT but can respond to MVD if there is a compressive vessel. Neurosurgeons should be aware of SUNCT, especially in patients with V1 TN and autonomic symptoms, to ensure that all potential medical therapies have been tried prior to surgical treatment.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.4.jns101843","type":"journal-article","created":{"date-parts":[[2011,5,13]],"date-time":"2011-05-13T14:19:18Z","timestamp":1305296358000},"page":"210-216","source":"Crossref","is-referenced-by-count":50,"title":["The importance of autonomic symptoms in trigeminal neuralgia"],"prefix":"10.3171","volume":"115","author":[{"given":"H. Neil","family":"Simms","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher R.","family":"Honey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns101843","series-title":"Semin Ophthalmol","first-page":"9","article-title":"SUNCT syndrome: Shortlasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing","volume":"21","author":"Alore","year":"2006"},{"key":"b2-jns101843","series-title":"Eur Surg Res","first-page":"51","article-title":"Microvascular decompression in trigeminal neuralgia with no vascular compression","volume":"39","author":"Baechli","year":"2007"},{"key":"b3-jns101843","series-title":"Pain","first-page":"367","article-title":"Differential modulation of nociceptive dural input to [hypocretin] orexin A and B receptor activation in the posterior hypothalamic area","volume":"109","author":"Bartsch","year":"2004"},{"key":"b4-jns101843","series-title":"Headache","first-page":"158","article-title":"SUNCT syndrome: a Hungarian case","volume":"35","author":"Becser","year":"1995"},{"key":"b5-jns101843","series-title":"Cephalalgia","first-page":"168","article-title":"\u201cSUNCT\u201d syndrome. A case of transformation from trigeminal neuralgia?","volume":"14","author":"Bouhassira","year":"1994"},{"key":"b6-jns101843","series-title":"Cephalalgia","first-page":"123","article-title":"Short-lasting unilateral neuralgiform headache attacks with tearing and conjunctival injection: the first \u201csymptomatic\u201d case?","volume":"11","author":"Bussone","year":"1991"},{"key":"b7-jns101843","series-title":"Brain","first-page":"2746","article-title":"Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or cranial autonomic features (SUNA)\u2014a prospective clinical study of SUNCT and SUNA","volume":"129","author":"Cohen","year":"2006"},{"key":"b8-jns101843","series-title":"Cephalalgia","first-page":"633","article-title":"Mechanisms of autonomic disturbance in the face during and between attacks of cluster headache","volume":"26","author":"Drummond","year":"2006"},{"key":"b9-jns101843","series-title":"J Neurol Neurosurg Psychiatry","first-page":"611","article-title":"Facial flushing after thermocoagulation of the Gasserian ganglion","volume":"46","author":"Drummond","year":"1983"},{"key":"b10-jns101843","series-title":"Cephalalgia","first-page":"996","article-title":"A case of a patient with SUNCT syndrome treated with Jannetta procedure","volume":"21","author":"Gardella","year":"2001"},{"key":"b11-jns101843","series-title":"Brain","first-page":"193","article-title":"A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic feature, including new cases","volume":"120","author":"Goadsby","year":"1997"},{"key":"b12-jns101843","series-title":"Cephalalgia","first-page":"82","article-title":"SUNCT syndrome or trigeminal neuralgia with lacrimation","volume":"21","author":"Goadsby","year":"2001"},{"key":"b13-jns101843","series-title":"Headache","first-page":"823","article-title":"SUNCT syndrome responsive to lamotrigine","volume":"42","author":"Gutierrez-Garcia","year":"2002"},{"key":"b14-jns101843","series-title":"Br J Neurosurg","first-page":"55","article-title":"Neurosurgical treatment of shortlasting, unilateral, neuralgiform hemicrania with conjunctival injection and tearing","volume":"16","author":"Hannerz","year":"2002"},{"issue":"Suppl 1","key":"b15-jns101843","series-title":"Cephalalgia","first-page":"9","article-title":"The International Classification of Headache Disorders: 2nd edition","volume":"24","author":"Headache Classification Subcommittee of the International Headache Society","year":"2004"},{"key":"b16-jns101843","series-title":"Exp Brain Res","first-page":"513","article-title":"Descending projections from the hypothalamic paraventricular nucleus to the A5 area, including the superior salivatory nucleus, in the rat","volume":"82","author":"Hosoya","year":"1990"},{"key":"b17-jns101843","series-title":"J Oral Biosci","first-page":"30","article-title":"Parasympathetic vasodilator fibres in the orofacial region","volume":"48","author":"Izumi","year":"2006"},{"key":"b18-jns101843","series-title":"Cephalalgia","first-page":"395","article-title":"Shortlasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome) and tumour of the cavernous sinus","volume":"23","author":"Kaphan","year":"2003"},{"key":"b19-jns101843","series-title":"Cephalalgia","first-page":"473","article-title":"SUNCT syndrome associated with compression of trigeminal nerve","volume":"25","author":"K\u00f6seoglu","year":"2005"},{"key":"b20-jns101843","series-title":"Neurosurgery","first-page":"E413","article-title":"Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome treated with microvascular decompression of the trigeminal nerve: case report","volume":"56","author":"Lagares","year":"2005"},{"key":"b21-jns101843","series-title":"J Neurosurg","first-page":"307","article-title":"Decreased carotid arterial resistance in cats in response to trigeminal stimulation","volume":"61","author":"Lambert","year":"1984"},{"key":"b22-jns101843","series-title":"Cephalalgia","first-page":"460","article-title":"A patient with SUNCT cured by the Jannetta procedure","volume":"17","author":"Lenaerts","year":"1997"},{"key":"b23-jns101843","series-title":"Curr Pain Headache Rep","first-page":"308","article-title":"Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome: a review","volume":"7","author":"Matharu","year":"2003"},{"issue":"Suppl 2","key":"b24-jns101843","series-title":"J Neurol Neurosurg Psychiatry","first-page":"ii19","article-title":"Trigeminal autonomic cephalgias","volume":"72","author":"Matharu","year":"2002"},{"key":"b25-jns101843","series-title":"Ann Neurol","first-page":"791","article-title":"Functional magnetic resonance imaging in spontaneous attacks of SUNCT: short-lasting neuralgiform headache with conjunctival injection and tearing","volume":"46","author":"May","year":"1999"},{"key":"b26-jns101843","series-title":"J Cereb Blood Flow Metab","first-page":"115","article-title":"The trigeminovascular system in humans: pathophysiologic implications for primary headache syndromes of the neural influences on the cerebral circulation","volume":"19","author":"May","year":"1999"},{"key":"b27-jns101843","series-title":"J Neurosurg","first-page":"1231","article-title":"Classification of trigeminal neuralgia: clinical, therapeutic, and prognostic implications in a series of 144 patients undergoing microvascular decompression. 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A clinical review","volume":"37","author":"Pareja","year":"1997"},{"key":"b31-jns101843","series-title":"JAMA","first-page":"1519","article-title":"The symptomatology of trifacial neuralgia","volume":"62","author":"Patrick","year":"1914"},{"key":"b32-jns101843","series-title":"Cephalalgia","first-page":"236","article-title":"Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) following presumed dorsolateral brainstem infarction","volume":"21","author":"Penart","year":"2001"},{"key":"b33-jns101843","series-title":"Acta Neurochir (Wien)","first-page":"100","article-title":"Facial pain. IV A prospective study of 1052 patients with a view of: precipitating factors, associated symptoms, objective psychiatric and neurological symptoms","volume":"108","author":"Rasmussen","year":"1991"},{"key":"b34-jns101843","series-title":"Cephalalgia","first-page":"398","article-title":"SUNCT syndrome: the first German case series","volume":"23","author":"Schwaag","year":"2003"},{"key":"b35-jns101843","series-title":"Cephalalgia","first-page":"151","article-title":"SUNCT syndrome or trigeminal neuralgia with lacrimation and conjunctival injection?","volume":"21","author":"Sesso","year":"2001"},{"key":"b36-jns101843","series-title":"Funct Neurol","first-page":"103","article-title":"Trigeminal neuralgia and \u201cSUNCT\u201d syndrome: similarities and differences in the clinical pictures. An overview","volume":"7","author":"Sjaastad","year":"1992"},{"key":"b37-jns101843","series-title":"Headache","first-page":"346","article-title":"Trigeminal neuralgia. Clinical manifestations of first division involvement","volume":"37","author":"Sjaastad","year":"1997"},{"key":"b38-jns101843","series-title":"Brain Res","first-page":"149","article-title":"CNS projections to the pterygopalatine parasympathetic preganglionic neurons in the rat: a retrograde transneuronal viral cell body labeling study","volume":"534","author":"Spencer","year":"1990"},{"key":"b39-jns101843","series-title":"J Neurol Neurosurg Psychiatry","first-page":"244","article-title":"Significance of atypical presentation of symptomatic SUNCT: a case report","volume":"70","author":"ter Berg","year":"2001"},{"key":"b40-jns101843","series-title":"J Clin Neurosci","first-page":"526","article-title":"SUNCT and SUNA: clinical features and medical treatment","volume":"15","author":"Williams","year":"2008"},{"key":"b41-jns101843","series-title":"Cephalalgia","first-page":"554","article-title":"Vertebral artery vascular loop in SUNCT and concomitant trigeminal neuralgia. 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