This article reviews the clinical features of and treatment options for the trigeminal autonomic cephalalgias (TACs).
The TACs are a group of primary headache disorders characterized by short-lasting episodes of severe unilateral headaches that are associated with ipsilateral cranial autonomic symptoms. The best known and most commonly seen TAC in clinical practice is cluster headache. The other syndromes within this group include paroxysmal hemicrania, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks. Although these disorders share a similar phenotype, they are distinguished by differences in attack frequency and duration. Recognition of these clinical differences is paramount because treatment options vary; paroxysmal hemicrania and hemicrania continua demonstrate an absolute response to treatment with indomethacin, while the other syndromes respond to other agents.
Although much less common than other headache disorders seen in clinical practice, recognition of the TACs is especially important as they are among the most severe and disabling syndromes in headache medicine.
Address correspondence to Dr Lawrence C. Newman, Mount Sinai-Roosevelt Hospital Headache Institute, 425 West 59th Street, Suite 4A, New York, New York, firstname.lastname@example.org.
Relationship Disclosure: Dr Newman serves as a consultant for Allergan, Inc; Depomed, Inc; and Teva Pharmaceutical Industries Ltd. Dr Newman receives personal compensation for speaking engagements from Allergan, Inc, and royalties from Oxford University Press and Springer Science + Business Media.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Newman discusses the unlabeled/investigational use of intranasal sumatriptan, zolmitriptan, and dihydroergotamine and oxygen inhalation as acute therapy for cluster headache; prednisone, dexamethasone, methylprednisolone, and occipital nerve blocks as bridge therapy for cluster headache; and verapamil, lithium carbonate, topiramate, and sodium valproate as preventive therapy for cluster headache. Dr Newman discusses the unlabeled/investigational use of indomethacin, melatonin, topiramate, verapamil, piroxicam, naproxen, and acetazolamide for the treatment of paroxysmal hemicrania; indomethacin, topiramate, melatonin, occipital nerve block, and occipital nerve stimulation for the treatment of hemicrania continua; and gabapentin, lamotrigine, topiramate, and lidocaine for the treatment of unilateral neuralgiform headache attacks.