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Trigeminal Autonomic Cephalalgias

Goadsby, Peter J. MD, PhD

CONTINUUM: Lifelong Learning in Neurology: August 2012 - Volume 18 - Issue 4, Headache - p 883–895
doi: 10.1212/01.CON.0000418649.54902.0b
Review Articles

Purpose of Review: This article covers the clinical manifestations and differential diagnosis of the trigeminal autonomic cephalalgias (TACs).

Recent Findings: TACs comprise a subgroup of primary headache disorders presenting with lateralized, often severe, pain accompanied by cranial autonomic features. The key syndromes are cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short-lasting unilateral neuralgiform headache attacks with cranial autonomic features (SUNA), and hemicrania continua. Lateralization of symptoms and signs is the key feature differentiating the TACs and migraine. When diagnosing a TAC, it is appropriate to consider underlying pituitary or pituitary region pathology. Cluster headache responds to oxygen and parenteral triptans, with verapamil having the most success for prevention. Paroxysmal hemicrania responds to indomethacin. SUNCT/SUNA responds to lamotrigine and topiramate. Hemicrania continua responds to indomethacin.

Summary: TACs are a unique group of primary headache syndromes with individual features and specific responses to treatment that make their identification crucial for optimum management.

Address correspondence to Dr Peter J. Goadsby, Headache Group–Department of Neurology, UCSF Headache Center, 1701 Divisadero Street, San Francisco, CA 94115, pgoadsby@headache.ucsf.edu.

Relationship Disclosure: Dr Goadsby participates in activities with Air Products and Chemicals, Inc.; Allergan, Inc.; Autonomic Technologies, Inc.; Amgen, Inc.; Boehringer Ingelheim; Boston Scientific Corporation; Bristol-Myers Squibb; CoLucid Pharmaceuticals, Inc.; Coherex Medical, Inc.; Eli Lilly and Company; eNeura Therapeutics; Linde; MAP Pharmaceuticals, Inc.; Medtronic, Inc.; Merck & Co., Inc.; NeurAxon; and Pfizer, Inc.; and receives research support from Amgen, Inc.; Boston Scientific Corporation; eNeura Therapeutics; GlaxoSmithKline; Miles for Migraine; and Merck & Co., Inc. Dr Goadsby has provided headache expert testimony.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Goadsby reports no disclosure.

© 2012 American Academy of Neurology