• Continuum (Minneap Minn) · Aug 2012

    Review Case Reports

    Trigeminal autonomic cephalalgias.

    • Peter J Goadsby.
    • Department of Neurology, UCSF Headache Center, San Francisco, CA, USA. pgoadsby@headache.ucsf.edu
    • Continuum (Minneap Minn). 2012 Aug 1;18(4):883-95.

    Purpose Of ReviewThis article covers the clinical manifestations and differential diagnosis of the trigeminal autonomic cephalalgias (TACs).Recent FindingsTACs 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.SummaryTACs are a unique group of primary headache syndromes with individual features and specific responses to treatment that make their identification crucial for optimum management.

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