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/SUNA | |
|---|---|---|---|
| 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
