Treatment Outcomes and MRI Features of SUNA: A Systematic Review and Meta-Analysis

BackgroundTrigeminal autonomic cephalalgias (TACs), including short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA), are rare but debilitating headaches. The pathophysiology and optimal treatment of SUNA remain poorly defined, compounded by disparities in healthcare access. ObjectivesTo systematically review and analyze the effectiveness of treatment options, clinical outcomes, and brain MRI findings for SUNA, and to identify gaps in the current evidence base. MethodologyFollowing 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. ResultsAmong 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 (Cochrans Q = 63.10, p-value < 0.0001, = 0.05). Lidocaine was effective for acute attacks (> 80%). Brain MRIs were mostly unremarkable, with some evidence suggesting neurovascular involvement. ConclusionLamotrigine 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.