Onset of secondary SUNCT syndrome with concomitant occipital neuralgia after dorsal medullary infarction.

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.