scholarly journals Trigeminal autonomic cephalalgias: a review

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.

SUNCT/SUNA in children and adolescents: Application of ICHD-3 criteria and treatment response: Case series of 13 SUNCT/SUNA pediatric cases

Cephalalgia ◽  
2020 ◽  
pp. 033310242095452
Author(s):  
Sharoon Qaiser ◽  
Andrew D Hershey ◽  
Joanne Kacperski
Keyword(s):  
Children And Adolescents ◽  
Treatment Options ◽  
Case Series ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Trigeminal Autonomic Cephalalgias ◽  
Pediatric Case ◽  
Trigeminal Autonomic Cephalalgia ◽  
Autonomic Symptoms

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.

Unilateral Photophobia or Phonophobia in Migraine Compared With Trigeminal Autonomic Cephalalgias

Cephalalgia ◽  
2008 ◽  
Vol 28 (6) ◽  
pp. 626-630 ◽  
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.

scholarly journals Paroxysmal hemicrania: A case report

2004 ◽  
Vol 132 (3-4) ◽  
pp. 99-103
Author(s):  
Jasna Zidverc-Trajkovic ◽  
Aleksandra Pavlovic ◽  
Milija Mijajlovic ◽  
Zagorka Jovanovic ◽  
Nadezda Sternic-Covickovic
Keyword(s):  
Primary Care ◽  
Differential Diagnosis ◽  
Case Report ◽  
Current Knowledge ◽  
Primary Headache ◽  
Response To Treatment ◽  
Paroxysmal Hemicrania ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Excellent Opportunity

Paroxysmal hemicrania (PH) is one of the trigeminai autonomie cephalgias (TACs), a group of primary headache disorders characterized by unilateral trigeminal distribution pain that occurs in association with prominent ipsilateral cranial autonomy features. The TACs are relatively rare, which is likely to be why they are poorly recognized in primary care. TACs will thus be referred to neurologists eventually, offering an excellent opportunity to diagnose and treat these patients. PH responds in a dramatic and absolute fashion to indomethacin. The importance of recognizing these syndromes is underscored by their excellent but highly selective response to treatment. This is the case report of our patient with PH and the review of current knowledge about pathophysiology of TACs, as well as differential diagnosis of other entities from this headache group.

Concomitant occurrence of different trigeminal autonomic cephalalgias: A case series and review of the literature

Cephalalgia ◽  
2013 ◽  
Vol 34 (3) ◽  
pp. 231-235 ◽  
Author(s):  
Andreas Totzeck ◽  
Hans-Christoph Diener ◽  
Charly Gaul
Keyword(s):  
Cluster Headache ◽  
Clinical Presentation ◽  
Case Series ◽  
Primary Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Trigeminal Autonomic Cephalalgias ◽  
Headache Disorders ◽  
Primary Headache Disorders

Introduction The trigeminal autonomic cephalalgias (TACs) subsume four primary headache disorders. Hemicrania continua is increasingly regarded as an additional TAC. In rare cases patients may present with two different TACs or a TAC and hemicrania continua. Cases We report four patients with two different TACs or one TAC and hemicrania continua. Two patients presented with cluster headache and paroxysmal hemicrania, one patient with cluster headache and hemicrania continua, and one patient suffered from cluster headache and SUNCT. Discussion While the International Classification of Headache Disorders (ICHD-II) proposes specific diagnostic criteria, the variability of clinical presentation may make clear diagnosis difficult. All patients fulfilled the ICHD-II criteria. The manifestation of two different TACs or hemicrania continua in one patient is uncommon but possible and should be taken into account especially when chronic headache patients present with changing headache symptoms.

Headache

2018 ◽  
Author(s):  
Benjamin W Friedman
Keyword(s):  
Differential Diagnosis ◽  
Clinical Characteristics ◽  
Sinus Thrombosis ◽  
International Headache Society ◽  
Primary Headache ◽  
Primary Headaches ◽  
Key Words Migraine ◽  
Secondary Headaches ◽  
Primary Headache Disorders ◽  
Greater Occipital Nerve

Headaches are one of the most common complaints of patients seen by emergency physicians. They can be classified as primary headaches, which have no identifiable underlying cause, and secondary headaches, which are classified according to their cause. The majority of headaches are benign in origin, and most patients with headache can be treated successfully in the emergency department and discharged home; however, some have potentially life-threatening causes, and consideration of a broad differential diagnosis for all patients is essential. This review covers the primary headache disorders, pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes. The figure shows areas of the brain sensitive to pain. Tables review differential diagnosis of headache, International Headache Society primary headache criteria, clinical characteristics of secondary headaches, high-risk clinical characteristics among patients with a headache peaking in intensity within 1 hour, drugs associated with headache, and parenteral treatment of acute migraine. This review contains 1 figure, 9 tables, and 58 references. Key words: migraine, calcitonin gene related peptide, greater occipital nerve block, venous sinus thrombosis, reversible cerebral vasoconstriction syndrome, Ottawa, subarachnoid, cluster headache, trigeminal autonomic cephalalgias, post-traumatic headache

Headaches

2021 ◽  
pp. 329-342
Author(s):  
Andrew D. Hershey
Keyword(s):  
Early Recognition ◽  
Primary Headache ◽  
Primary Care Providers ◽  
School Nurses ◽  
Primary Headaches ◽  
Care Providers ◽  
Primary Headache Disorders ◽  
Tension Type Headaches ◽  
The Impact

This chapter discusses recurrent headaches, especially when episodic, which are much more likely to represent primary headache disorders. Primary headaches are intrinsic to the nervous system and are the disease itself. Early recognition of the primary headaches in patients should result in improved response and outcome, minimizing the impact of the primary headaches and disability. Primary headaches can be grouped into migraine, tension-type headaches, and trigeminal autonomic cephalalgia, and an additional grouping of rarer headaches without a secondary cause. The primary headache that has the greatest impact on a child’s quality of life and disability is migraine, and subsequently is the most frequent primary headache brought to the attention of parents, primary care providers, and school nurses.

Classification, diagnostic criteria, and epidemiology

2020 ◽  
pp. 177-181
Author(s):  
Thijs H. Dirkx ◽  
Peter J. Koehler
Keyword(s):  
Cluster Headache ◽  
Epidemiological Data ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Conjunctival Injection ◽  
Headache Disorders ◽  
Cranial Autonomic Symptoms ◽  
Unilateral Headache

The trigeminal autonomic cephalalgias (TACs), including cluster headache, paroxysmal hemicrania, SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing), SUNA (with cranial autonomic symptoms), and hemicrania continua, belong to the primary headaches. They are characterized by severe unilateral headache attacks in association with ipsilateral cranial autonomic features. Cluster headache is the most frequent of the TACs. The other TACs are rare, but epidemiological data are scarce and variable. The various types of TAC are distinguished not only by differences in attack frequency and duration, but also by differences with respect to treatment response. The typical headache syndromes, fulfilling the International Classification of Headache Disorders-3 criteria, have also been described in association with other disorders and imaging is required to exclude intracranial pathology in all newly diagnosed patients.

Sign in / Sign up

Export Citation Format

Share Document