[Cluster headache and other trigeminal autonomic cephalalgias]

Area of Science:

• Neurology
• Headache Medicine

Background:

• Trigeminal autonomic cephalalgias (TACs) are a group of four primary headache syndromes.
• These syndromes share common pathophysiological and clinical features, including strictly unilateral, intense headache attacks with ipsilateral cranial autonomic symptoms or restlessness.

Purpose of the Study:

• To provide an overview of the four TACs: cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua.
• To highlight the diagnostic distinctions based on attack duration and frequency.
• To discuss current and emerging treatment options.

Main Methods:

• Review of clinical characteristics and diagnostic criteria for TACs.
• Summary of established and novel therapeutic approaches.

Main Results:

• The four TACs are distinguished by headache attack duration and frequency.
• Paroxysmal hemicrania and hemicrania continua generally respond well to indomethacin.
• Various neuromodulation therapies, including vagus nerve, sphenopalatine ganglion, occipital nerve stimulation, and deep brain stimulation, are increasingly available.

Conclusions:

• TACs represent a distinct group of primary headaches requiring specific management strategies.
• Effective treatment relies on accurate diagnosis and tailored therapeutic interventions, encompassing both traditional and advanced neuromodulation options.