Attacks of moderate or severe, strictly unilateral head pain lasting seconds to minutes, occurring at least once a day and usually associated with prominent lacrimation and redness of the ipsilateral eye.
- At least 20 attacks fulfilling criteria B–D
- Moderate or severe unilateral head pain, with orbital, supraorbital, temporal and/or other trigeminal distribution, lasting for 1–600 seconds and occurring as single stabs, series of stabs or in a saw-tooth pattern
- At least one of the following five cranial autonomic symptoms or signs, ipsilateral to the pain:
- conjunctival injection and/or lacrimation
- nasal congestion and/or rhinorrhoea
- eyelid oedema
- forehead and facial sweating
- forehead and facial flushing
- sensation of fullness in the ear
- miosis and/or ptosis
- Occurring with a frequency of at least one a day1
- Not better accounted for by another ICHD-3 diagnosis.
During part, but less than half, of the active time-course of 3.3 Short-lasting unilateral neuralgiform headache attacks, attacks may be less frequent.
Longer-duration attacks are characterized by multiple stabs or a saw-tooth pain pattern.
Two subtypes of 3.3 Short-lasting unilateral neuralgiform headache attacks are recognized: 3.3.1 Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and 3.3.2 Short lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). 3.3.1 SUNCT may be a subform of 3.3.2 SUNA, although this requires further study. Meanwhile, each is classified as a separate subtype, described below.
3.3.1 SUNCT and 3.3.2 SUNA can usually be triggered without a refractory period. This is in contrast to 13.1.1 Trigeminal neuralgia, which usually has a refractory period after each attack.