Pain Part 9: Trigeminal Autonomic Cephalalgias

The trigeminal autonomic cephalalgias are a group of rare, highly disabling, primary headache syndromes distinctly characterized by the unilaterality of their attacks and presence of cranial autonomic symptoms. Although pain is often localized to the peri-orbital and temporal regions, it is not uncommon for pain to radiate to tooth-bearing areas and mimic toothache or jaw pain. Hence, dental practitioners should be aware of these syndromes to enable appropriate referral and avoid unnecessary, and often irreversible, dental treatments. Many dentists will not have heard of these conditions but must remain vigilant, and ensure that they are not confused with trigeminal neuralgia, so that their patients are appropriately advised and referred. Clinical relevance: The dental practitioners may be the first line of healthcare providers consulted by these patients in the hope of obtaining pain relief. Lack of familiarity with an uncommon condition may lead to poor patient management.