Chapter 4 Cluster and other trigeminal autonomic cephalalgias
Anna S Cohen
• Trigeminal autonomic cephalalgias (TACs) are characterized by attacks of severe unilateral pain and accompanying ipsilateral cranial autonomic features.
• Attacks of paroxysmal hemicrania (PH) and SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) are more frequent and shorter than in cluster headache (CH).
• In CH, the episodic form prevails; in other TACs, the chronic form is more common.
• Characteristic triggers for attacks include alcohol for CH, and cutaneous triggers for SUNCT.
• All TACs are generally primary syndromes, but underlying lesions such as pituitary tumours and posterior fossa lesions must be excluded.
• Brain magnetic resonance imaging is the recommended investigation for all new diagnoses of TAC.
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