Symptoma

Trigeminal Autonomic Cephalalgia

CLINICAL PRESENTATION: Case 1: A 51-year-old woman presented with severe pain in the maxillary and mandibular left molars. [ncbi.nlm.nih.gov]

Clinical Presentation: Case 1: A 51-year-old woman presented with severe pain in the maxillary and mandibular left molars. [scholarlycommons.pacific.edu]

  • Hiccup

    Neuromyelitis Optica (NMO) can have atypical presentations like hiccups, vomiting, etc. which is classically described as the area postrema syndrome. [ncbi.nlm.nih.gov]

  • Foreign Body Sensation

    HC is probably much more common than originally thought and often misdiagnosed. 2 HC can also be accompanied by idiopathic stabbing headache, often called “jabs and jolts,” and is frequently associated with an ipsilateral foreign body sensation in the [neurology.org]

  • Distractibility

    Thus, CH attacks frequently wake patients out of sleep. 3 Finally, the clinician should not be distracted by migrainous symptoms—photophobia can occur in 91% and phonophobia in 89% of CH attacks, and nausea occurs frequently in cluster as well. 4 All [neurology.org]

  • Severe Unilateral Headaches

    TACs are a rare group of headache disorders characterized by severe unilateral headache in the V1 distribution of the trigeminal nerve and autonomic symptoms. This presentation in NMO is hitherto unreported in literature. [ncbi.nlm.nih.gov]

    The TACs are a group of primary headache disorders characterized by short-lasting episodes of severe unilateral headaches that are associated with ipsilateral cranial autonomic symptoms. [journals.lww.com]

HC can also be accompanied by idiopathic stabbing headache, often called “jabs and jolts,” and is frequently associated with an ipsilateral foreign body sensation in the eye, like an eyelash or grit. 13,14 MRIs of the brain are mandatory during the workup [neurology.org]

Despite the existence of clear-cut diagnostic criteria (The International Classification of Headache Disorders, 2 nd edition - ICHD-II) and several therapeutic guidelines, errors in workup and treatment of these conditions are frequent in clinical practice [thejournalofheadacheandpain.springeropen.com]

CONCLUSION: Supraorbital/supratrochlear nerve stimulation appears to be a promising modality for the treatment of patients with intractable TAC. 2012 International Neuromodulation Society. [ncbi.nlm.nih.gov]

[…] occipital nerve stimulation for the treatment of hemicrania continua; and gabapentin, lamotrigine, topiramate, and lidocaine for the treatment of unilateral neuralgiform headache attacks. 2015 American Academy of Neurology [journals.lww.com]

No known effective treatment for new daily persistent headache, but standard acute and prophylactic treatments for chronic migraine and chronic tension-type headache can be tried; rarely, patients may also respond to doxycycline [cram.com]

Incidence is rare when compared to other primary headache disorders but diagnosis (and, more importantly, treatment) can prove to be a challenge even when presented with a typical clinical presentation. [neurology.org]

Arterial vasodilation and perivascular inflammation leading to neurogenic inflammation are suggested as a common etiological feature of both migraines and the TACs. [headachejournal.org]

[…] headache, often called “jabs and jolts,” and is frequently associated with an ipsilateral foreign body sensation in the eye, like an eyelash or grit. 13,14 MRIs of the brain are mandatory during the workup, as secondary HC has been reported, often with etiologies [neurology.org]

• Reversible cerebral vasoconstriction syndrome (RCVS) should be considered as possible underlying etiology before the diagnosis of primary headache associated with sexual activity. • Cluster headache may be also responsive to indomethacin. [medlink.com]

SUNCT syndrome responding absolutely to steroids in two cases with different etiologies. J Headache Pain. 2009;10(1):55–7. CrossRef Google Scholar 40. Domingos J, Pereira PJ, Roriz MJ, Xavier AJ, Magalhaes M, Monteiro PJ. [link.springer.com]

CCFs can be classified by etiology (traumatic vs. spontaneous), velocity of blood flow (high vs. low flow), and anatomy (direct vs. dural). [8] Some fistulas Direct CCFs are characterized by a direct connection between the cavernous segment of the internal [mjdrdypu.org]

Epidemiology of the TACs Although rare disorders, the TACs and CH specifically may have a genetic preponderance. [acnr.co.uk]

CH comes in 2 epidemiologic forms. [neurology.org]

Vågå study of headache epidemiology. J Headache Pain, 2007;8:19-27 14. Prakash S, Golwala P (2012) A proposal for revision of hemicrania continua diagnostic criteria based on critical analysis of 62 patients. Cephalalgia32:860–868 15. [pulsetoday.co.uk]

Vaga study of headache epidemiology. Cephalalgia 2003 ; 23 : 528 –33. Boes CJ, Swanson JW, Dodick DW. [doi.org]

Vaga study of headache epidemiology. Cephalalgia 2003, 23 (7):528–533. PubMed View Article Google Scholar Alonso AA, Nixdorf DR: Case series of four different headache types presenting as tooth pain. J Endod 2006, 32 (11):1110–1113. [thejournalofheadacheandpain.springeropen.com]

The existence of secondary cases may lead to a better understanding of the pathophysiology of trigeminal autonomic cephalalgias. [ncbi.nlm.nih.gov]

Their therapy is beyond the scope of the present paper, but it has been recently reviewed. 4 PATHOPHYSIOLOGY OF TACS Any pathophysiological construct for TACs must account for the two major shared clinical features characteristic of the various conditions [doi.org]

METHOD: Hemicrania continua, a continuous, unilateral, side-locked headache, absolutely responsive to preventive treatment with indomethacin, is contrasted with so-called medication-overuse headache, in which the paradoxical situation exists of tremendous [ncbi.nlm.nih.gov]

Otherwise, prevention is added as soon as the patient notes the cluster period has begun. Prevention might not be needed if at the end of a cycle. The mainstay of preventive therapy is verapamil. [neurology.org]

Short-term preventive therapies are useful in CH and SUNCT, in order to allow a pain-free window for titration of preventive medications. [acnr.co.uk]

[…] dihydroergotamine and oxygen inhalation as acute therapy for cluster headache; prednisone, dexamethasone, methylprednisolone, and occipital nerve blocks as bridge therapy for cluster headache; and verapamil, lithium carbonate, topiramate, and sodium valproate as preventive [journals.lww.com]