Trigeminal autonomic cephalgias (TACs) are a set of disabling primary headache and facial pain disorders characterized by unilateral, excruciating facial pain and autonomic dysfunction on the same side.

Pain is often contained in the ophthalmic and upper mandibular branches of the trigeminal nerve, the regions of the eye and cheek.

Autonomic symptoms include:

  • redness and watering of the eye (conjunctival injection and lacrimation)
  • one-sided nasal congestion or discharge (rhinorrhea)
  • forehead and facial sweating
  • constriction of a pupil
  • drooping and swelling of an eyelid (miosis, ptosis and eyelid edema)

While individual TACs share overlapping symptoms, each one generally responds to a specific treatment. Individual TACs may be clinically differentiated by attention to frequency, duration, and recurrence rate of attacks. As these disorders often present as symptoms of an underlying pathology, neuro-imaging is imperative.

Cluster Headache Paroxysmal hemicrania SUNCT
Female to Male Ratio
1:4 2:1 1:2
Pain
Type Stabbing, boring Throbbing, boring, stabbing Burning, stabbing, sharp
Severity Severe to excruciating Excruciating Moderate to severe
Site Orbit, temple, face Orbit, temple Periorbital
Attack frequency 1/alternate day–8 daily 1–40/day 1/day–30/hour
Duration of attack 15–180 minutes 2–30 minutes 5–240 seconds
Autonomic features Yes Yes Yes
Migrainous features Yes Yes Possible photophobia
Alcohol trigger Yes Occasional No

Table: J Neurol Neurosurg Psychiatry 2005;76:301-305 doi:10.1136/jnnp.2004.036012