Chapter 015. Headache (Part 14)

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Table Cephalalgias 15-8 Clinical Features of the Trigeminal Autonomic Cluster Headache Paroxysmal Hemicrania SUNCT Gender MF F=M F~M Pain Type boring Stabbing, Throbbing, boring, stabbing Burning, stabbing, sharp Severity Excruciating Excruciating Severe excruciating to Site Orbit, temple Orbit, temple Periorbital Attack frequency 1/alternate day– 8/d 1–40/d (5/d for more than half the time) 3–200/d Duration attack of 15–180 min 2–30 min 5–240 s Autonomic features Yes Yes Yes (prominent conjunctival injection lacrimation)a and Migrainous featuresb Yes Yes Yes Alcohol trigger Yes No No Cutaneous triggers No No Yes Indomethaci n effect — Yesc — Abortive treatment Sumatriptan No effective (IV) Lidocaine injection or nasal treatment spray Oxygen Prophylactic treatment Verapamil n Methysergid Indomethaci e Lamotrigin e Topiramate Lithium Gabapentin ...

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Chapter 015. Headache (Part 14) Table 15-8 Clinical Features of the Trigeminal Autonomic Cephalalgias Cluster Paroxysmal SUNCT Headache Hemicrania Gender M>F F=M F~M Pain
Type Stabbing, Throbbing, Burning, boring boring, stabbing stabbing, sharp Severity Excruciating Excruciating Severe to excruciating Site Orbit, temple Orbit, temple Periorbital Attack 1/alternate 1–40/d (>5/d 3–200/d frequency day– 8/d for more than half the time) Duration of 15–180 min 2–30 min 5–240 s attack Autonomic Yes Yes Yes features (prominent conjunctival injection and lacrimation)a
Migrainous Yes Yes Yes featuresb Alcohol Yes No No trigger Cutaneous No No Yes triggers Indomethaci — Yesc — n effect Abortive Sumatriptan No effective Lidocaine treatment injection or nasal treatment (IV) spray Oxygen Prophylactic Verapamil Indomethaci Lamotrigin treatment n e Methysergid
e Topiramate Lithium Gabapentin a If conjunctival injection and tearing not present, consider SUNA. b Nausea, photophobia, or phonophobia; photophobia and phonophobia are typically unilateral on the side of the pain. c Indicates complete response to indomethacin. Note: SUNCT, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing TACs must be differentiated from short-lasting headaches that do not have prominent cranial autonomic syndromes, notably trigeminal neuralgia, primary stabbing headache, and hypnic headache. The cycling pattern and length, frequency, and timing of attacks are useful in classifying patients. Patients with TACs should undergo pituitary imaging and pituitary function tests as there is an excess of TAC presentations in patients with pituitary tumor–related headache.