Trigeminal autonomic headaches
Keywords:
trigeminal autonomic headaches, pathogenesis, treatmentAbstract
Trigeminal autonomic headaches (TACs) include cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA), and hemicrania continua. Activation of central sympathetic and parasympathetic mechanisms and peripheral sympathetic deficits are involved in the pathogenesis. Hypothalamic overactivity leads to impaired pain modulation, trigeminal sensitization, and cranial autonomic activation. The posterior hypothalamus is associated with headache seizure termination and regulates its duration, which differentiates individual trigeminal autonomic cephalgias. Clinical features common to TAC are the combination of a short-lasting unilateral headache and marked cranial parasympathetic autonomic symptoms in the head region innervated by the trigeminal nerve, which are lateralized and ipsilateral to the headache. They differ from each other in the frequency and duration of attacks and the response to treatment. Cluster headache has the longest seizure duration but the lowest frequency. SUNCT has the shortest seizure duration but the highest seizure frequency. Paroxysmal hemicrania has intermediate frequency and duration. Paroxysmal hemicrania proceeds with severe pain, which never changes its side, the attacks are shorter and their number is greater. Accompanying cranial autonomic symptoms are ipsilateral ptosis or swelling of the eyelid, miosis, conjunctival injection, lacrimation, nasal congestion, rhinorrhea and sweating of the forehead and face. These are completely responded by indomethacin.
SUNCT proceeds with a severe, unilateral, short-lasting, headache in the area innervated by the ophthalmic branch of the trigeminal nerve. The average number of daily attacks is 16. Accompanying autonomic symptoms are ipsilateral – conjunctival injection, lacrimation, rhinorrhea, nasal congestion, eyelid edema, ptosis, miosis, facial flushing and sweating. SUNA proceeds with typical headache, but with conjunctival injection only or lacrimation only. Hemicrania continua proceeds with a daily, persistent, background headache, dull and pressing, strictly unilateral, constant and prolonged, without remission, of moderate intensity.
Ipsilateral autonomic symptoms may accompany the pain during exacerbations. Well influenced by prophylactic treatment with indomethacin.
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https://glavobolie.org/journal/index.php/ce/article/view/61
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