Treatment of Trigeminal Autonomic Cephalalgias and Other Primary Headaches

Introduction Trigeminal autonomic cephalalgias (TACs) are characterized by paroxysmal attacks of unilateral primary headaches associated with ipsilateral craniofacial autonomic symptoms. In this pediatric case series, 13 cases of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA), including children ages 3–18 years, are discussed. This paper reviews the application of International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria especially in children presenting with SUNCT or SUNA. This is the largest pediatric case series of SUNCT/SUNA reported in the literature. Background Trigeminal autonomic cephalalgias are rare in children and adolescents, with SUNCT/SUNA having the least reported cases. We will discuss the application of ICHD-3 criteria to diagnose SUNCT/SUNA in children and review overlapping cases and their response to different treatment options including indomethacin, which is typically reserved for specific subtypes of TACs; for example, paroxysmal hemicrania. Conclusion This case series presents a unique opportunity to aid in the diagnosis and treatment of similar pediatric cases in the future. It helps us to broaden the ICHD-3 criteria to diagnose and treat different overlapping trigeminal autonomic cephalalgia cases in children.

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Unilateral Photophobia or Phonophobia in Migraine Compared With Trigeminal Autonomic Cephalalgias

Cephalalgia ◽

10.1111/j.1468-2982.2008.01565.x ◽

2008 ◽

Vol 28 (6) ◽

pp. 626-630 ◽

Cited By ~ 69

Author(s):

P Irimia ◽

E Cittadini ◽

K Paemeleire ◽

AS Cohen ◽

PJ Goadsby

Keyword(s):

Cluster Headache ◽

Clinical Symptoms ◽

Medication Overuse Headache ◽

Episodic Migraine ◽

Chronic Cluster Headache ◽

Hemicrania Continua ◽

Paroxysmal Hemicrania ◽

Primary Headaches ◽

Trigeminal Autonomic Cephalalgias ◽

A Prospective Study

Our objective was to compare the presence of self-reported unilateral photophobia or phonophobia, or both, during headache attacks comparing patients with trigeminal autonomic cephalalgias (TACs)—including cluster headache, shortlasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and paroxysmal hemicrania—or hemicrania continua, and other headache types. We conducted a prospective study in patients attending a referral out-patient clinic over 5 months and those admitted for an intramuscular indomethacin test. Two hundred and six patients were included. In episodic migraine patients, two of 54 (4%) reported unilateral photophobia or phonophobia, or both. In chronic migraine patients, six of 48 (13%) complained of unilateral photophobia or phonophobia, or both, whereas none of the 24 patients with medication-overuse headache reported these unilateral symptoms, although these patients all had clinical symptoms suggesting the diagnosis of migraine. Only three of 22 patients (14%) suffering from new daily persistent headache (NDPH) experienced unilateral photophobia or phonophobia. In chronic cluster headache 10 of 21 patients (48%) had unilateral photophobia or phonophobia, or both, and this symptom appeared in four of five patients (80%) with episodic cluster headache. Unilateral photophobia or phonophobia, or both, were reported by six of 11 patients (55%) with hemicrania continua, five of nine (56%) with SUNCT, and four of six (67%) with chronic paroxysmal hemicrania. Unilateral phonophobia or photophobia, or both, are more frequent in TACs and hemicrania continua than in migraine and NDPH. The presence of these unilateral symptoms may be clinically useful in the differential diagnosis of primary headaches.

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POTENTIAL GENDER DIFFERENCES IN PATHOPHYSIOLOGY OF MIGRAINE AND TENSION TYPE HEADACHE

Human Care Journal ◽

10.32883/hcj.v5i2.749 ◽

2020 ◽

Vol 5 (2) ◽

pp. 539

Author(s):

Restu Susanti

Keyword(s):

Gender Differences ◽

Sex Differences ◽

Psychosocial Factors ◽

Primary Headache ◽

Tension Type Headache ◽

Primary Headaches ◽

Trigeminal Autonomic Cephalalgias ◽

Migraine Headaches ◽

Type Headache ◽

Underlying Diseases

Headache is one of the most common symtomps which cause patients consult a neurologist. Primary headache is headache without other underlying diseases. Primary headaches can be divided into migraine headaches, tension types-headache, trigeminal autonomic cephalalgias, and other types of headaches. Sex differences play a role in the perception of headache. Theories regarding hormonal, the number of pain-sensitive points, subjectivity, and psychosocial factors are mostly related to the differences of migraine and TTH pathophysiology between women and men.

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Trigeminal autonomic cephalalgias: a review

Aktualności Neurologiczne ◽

10.15557/an.2016.0023 ◽

2016 ◽

Vol 16 (4) ◽

pp. 180-186

Author(s):

Michał Modestowicz ◽

◽

Wojciech Kozubski ◽

Keyword(s):

Functional Neuroimaging ◽

Posterior Hypothalamus ◽

Vascular Pathology ◽

Response To Treatment ◽

Paroxysmal Hemicrania ◽

Surgical Approaches ◽

Primary Headaches ◽

Trigeminal Autonomic Cephalalgias ◽

Primary Stabbing Headache ◽

Primary Headache Disorders

Trigeminal autonomic cephalalgias are a group of primary headache disorders presenting as unilateral pain in the somatic distribution of the trigeminal nerve, associated with ipsilateral cranial autonomic symptoms. This clinicopathologic group includes cluster headache, paroxysmal hemicrania, hemicrania continua and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/cranial autonomic features, which differ mainly as regards the duration and frequency of pain as well as response to treatment. These disorders are not as rare as they were thought to be and due to the severity of the pain can substantially affect the patients’ quality of life. Many other forms of primary headaches, such as migraine, trigeminal neuralgia and primary stabbing headache, as well as secondary headaches, particularly those caused by pituitary, posterior fossa, orbital, paranasal sinus and vascular pathology, need to be carefully considered in the diagnosis of trigeminal autonomic cephalalgias. Research in this field, particularly using functional neuroimaging, has resulted in a much better understanding of these disorders. Dysfunction in the nociceptive modulatory pathways in brain’s pain matrix is currently thought to produce a permissive state for the occurrence of a trigeminal autonomic cephalalgia attack, with posterior hypothalamus serving as a terminator rather than the generator of the attack. The current treatment strategies include medical and surgical approaches; of the latter, neuromodulation techniques, particularly deep brain stimulation of posterior hypothalamus, have proven to be particularly effective and promising.

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Treatment of Trigeminal Autonomic Cephalalgias and Other Primary Headaches

The Cleveland Clinic Manual of Headache Therapy ◽

10.1007/978-3-319-04072-1_12 ◽

2014 ◽

pp. 179-193

Author(s):

Mark J. Stillman

Keyword(s):

Primary Headaches ◽

Trigeminal Autonomic Cephalalgias

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Sleep disturbance management in patients with trigeminal autonomic cephalalgias

Medical Council ◽

10.21518/2079-701x-2021-19-100-108 ◽

2021 ◽

pp. 100-108

Author(s):

N. V. Vashchenko ◽

A. M. Uzhakhov ◽

Ju. E. Azimova

Keyword(s):

Cluster Headache ◽

Vagus Nerve ◽

Sleep Disturbances ◽

Primary Headaches ◽

Prophylactic Therapy ◽

Trigeminal Autonomic Cephalalgias ◽

Trigeminovascular System ◽

Acute Therapy

Trigeminal autonomic cephalalgias (TACs) are rare but are the most intense primary headaches that severely limit patients’ ability to work and be socially active. This article reviews the modern classification of TACs, based on the International Classification of Headache Disorders-3, and the key differences between TAC types, as well as the pathophysiological mechanisms – the role of the trigeminovascular system, autonomic nervous system, hypothalamus and vagus nerve – and their relation to circadian rhythms. The sleep disturbances that can occur in patients with TACs, exacerbating the course of the disease, and the role of melatonin, hypothalamus and suprachiasmatic nucleus in these conditions are also discussed. In addition, current therapies for cluster headache are described, which include acute therapy and prophylactic therapy, with recommendations regarding the timing of prophylactic therapy discontinuation. The review also includes the available data on melatonin as well as new therapies such as CGRP monoclonal antibodies and neuromodulation, which includes the two most promising techniques: non-invasive vagus nerve stimulation and sphenopalatine ganglion microstimulation. Furthermore, the authors present the clinical case of a patient with chronic cluster headache, which was significantly reduced in frequency and intensity when melatonin was added to the therapy.

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Faculty Opinions recommendation of Management of trigeminal autonomic cephalalgias in children and adolescents.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718007486.793476031 ◽

2013 ◽

Author(s):

Anna Cohen

Keyword(s):

Children And Adolescents ◽

Trigeminal Autonomic Cephalalgias

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Reference programme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 3rd edition, 2020

The Journal of Headache and Pain ◽

10.1186/s10194-021-01228-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Henrik W. Schytz ◽

Faisal M. Amin ◽

Rigmor H. Jensen ◽

Louise Carlsen ◽

Stine Maarbjerg ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Primary Care Physicians ◽

Facial Pain ◽

Common Interest ◽

Diagnosis And Treatment ◽

Primary Headaches ◽

Secondary Headache ◽

Great Success ◽

Headache Disorders

AbstractHeadache and facial pain are among the most common, disabling and costly diseases in Europe, which demands for high quality health care on all levels within the health system. The role of the Danish Headache Society is to educate and advocate for the needs of patients with headache and facial pain. Therefore, the Danish Headache Society has launched a third version of the guideline for the diagnosis, organization and treatment of the most common types of headaches and facial pain in Denmark. The second edition was published in Danish in 2010 and has been a great success, but as new knowledge and treatments have emerged it was timely to revise the guideline. The recommendations for the primary headaches and facial pain are largely in accordance with the European guidelines produced by the European Academy of Neurology. The guideline should be used a practical tool for use in daily clinical practice for primary care physicians, neurologists with a common interest in headache, as well as other health-care professionals treating headache patients. The guideline first describes how to examine and diagnose the headache patient and how headache treatment is organized in Denmark. This description is followed by sections on the characteristics, diagnosis and treatment of each of the most common primary and secondary headache disorders and trigeminal neuralgia. The guideline includes many tables to facilitate a quick overview. Finally, the particular challenges regarding migraine and female hormones as well as headache in children are addressed.

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