trigeminal autonomic cephalgia
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Introduction
A group of headache disorders
Classification
- cluster headache (most common)
- paroxysmal hemicrania
- Short-lasting Unilateral Neuralgiform headache attacks
- with Conjunctival injection & Tearing syndrome (SUNCT syndrome)
- with autonomic symptoms (SUNA syndrome)
Clinical manifestations
- severe unilateral headache
- periorbital, nocturnal (cluster headache)
- trigeminal pain in the distribution of CN5-1 (ophthalmic nerve)
- periorbital, frontal, temporal
- occurs in association with prominant ipsilateral cranial autonomic features
- different syndromes differ in duration, frequency of episodes & response to therapy
- cluster headache lasts the longest (median duration 1 hour) with a frequncy of 1-3/day (case: 2-3 hours)
- paroxysmal hemicrania mean duration 15 minutes with a mean of 11 episodes/day
- SUNCT syndrome mean duration 1 minute with 30-200 episodes/day
Laboratory
- erythrocyte sedimentation rate & serum C-reactive protein for suspected temporal arteritis
Differential diagnosis
- distinguish from trigeminal neuralgia which typically involves CN5-2 (maxillary nerve) or CN5-3 (mandibular nerve) with sensory ouput (lancinating pain) but without autonomic features
- the different trigeminal autonomic cephalgias (see Classification above) are distinguished on the basis of duration &/or frequency of headache[3]
Management
- cluster headache prophylaxis responds best to verapamil
- abort with subcutaneous sumatriptin or high flow oxygen therapy
- paroxysmal hemicrania responds best to indomethacin
- SUNCT syndrome may respond best to lamotrigine
More general terms
More specific terms
- cluster headache (suicide headache)
- paroxysmal hemicrania
- Short-lasting Unilateral Neuralgiform headache attacks with autonomic symptoms syndrome (SUNA syndrome)
- Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection & Tearing syndrome (SUNCT syndrome)
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ Goadsby PJ, Cittadini E, Cohen AS. Trigeminal autonomic cephalalgias: paroxysmal hemicrania, SUNCT/SUNA, and hemicrania continua. Semin Neurol. 2010 Apr;30(2):186-91 PMID: https://www.ncbi.nlm.nih.gov/pubmed/2035258
- ↑ 3.0 3.1 Pareja JA, Alvarez M. The usual treatment of trigeminal autonomic cephalalgias. Headache. 2013 Oct;53(9):1401-14. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24090529