Trigeminal autonomic cephalalgias

Abstract

The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders characterised by lateralized symptoms: prominent headache and ipsilateral cranial autonomic features, such as conjunctival injection, lacrimation and rhinorrhea. The TACs are: cluster headache (CH), paroxysmal hemicrania (PH), short‐lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short‐lasting neuralgiform headache attacks with cranial autonomic features (SUNA) and hemicrania continua (HC). Their diagnostic criteria are outlined in the International Classification of Headache Disorders, third edition‐beta (ICHD‐IIIb). These conditions are distinguished by their attack duration and frequency, as well as response to treatment. HC is continuous and by definition responsive to indomethacin. The main differential when considering this headache is chronic migraine. Other TACs are remarkable for their short duration and must be distinguished from other short‐lasting painful conditions, such as trigeminal neuralgia and primary stabbing headache. Cluster headache is characterised by exquisitely painful attacks that occur in discrete episodes lasting 15–180 min a few times a day. In comparison, PH occurs more frequently and is of shorter duration, and like HC is responsive to indomethacin. SUNCT/SUNA is the shortest duration and highest frequency TAC; attacks can occur over a hundred times every day.

CGRP and the Trigeminal System in Migraine

“…Unlike migraine, cluster headache is not common, occurring in <1% of the population, and its pathophysiology remains largely obscure . Cluster headache is a trigeminal autonomic cephalalgia characterized by severe, strictly unilateral painful attacks of discrete episodes of 15‐180 minutes each, usually occurring in clusters with long periods of remission between clusters.…”

“…Others suggest that the posterior hypothalamus regulates the duration, rather than the generation, of cluster headache attacks . The pathophysiology of cluster headache has been the subject of several recent reviews …”

“…Unlike migraine, cluster headache is not common, occurring in <1% of the population, and its pathophysiology remains largely obscure. 6,177,178 Cluster headache is a trigeminal autonomic cephalalgia characterized by severe, strictly unilateral painful attacks of discrete episodes of 15-180 minutes each, usually occurring in clusters with long periods of remission between clusters. The trigeminal distribution of pain, the circadian and circannual periodicity of the cluster episodes, and the autonomic symptoms ipsilateral to the pain represent the 3 major features of cluster headache.…”

Tics in TACs: A Step into an Avalanche? Systematic Literature Review and Conclusions

“…Trigeminal autonomic cephalalgias (TACs) and trigeminal neuralgia (TN, “tic douloureux”) are rare disorders characterized by unilateral cranial or facial pain. With respect to TACs, the International Classification of Headache Disorders (third edition, beta version, ICHD‐3 beta) differentiates cluster headache (CH), paroxysmal hemicrania (PH), short‐lasting unilateral neuralgiform headache attacks with its subtypes SUNCT (short‐lasting neuralgiform headache attacks with conjunctival injection and tearing) and SUNA (short‐lasting neuralgiform headache attacks with cranial autonomic symptoms), and hemicrania continua (HC) . With respect to TN, classical TN is differentiated from painful trigeminal neuropathy…”

“…In TACs, headache is associated with cranial autonomic symptoms ipsilateral to the side of the pain . Pain duration, frequency of attacks, and response to indomethacin are most important for differentiating TACs from each other . The detailed diagnostic criteria are summarized in Table .…”