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Pathophysiology of the trigeminal autonomic cephalalgias

Arne May, MD
Anna S Cohen, MD
Peter J Goadsby, MD, PhD
Section Editor
Jerry W Swanson, MD, MHPE
Deputy Editor
John F Dashe, MD, PhD


The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders characterized by unilateral trigeminal distribution pain that occurs in association with prominent ipsilateral cranial autonomic features [1,2]. The 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 [3].

Despite their common elements, the TACs differ in attack duration and frequency, as well as the response to therapy (table 1).

Cluster headache has the longest attack duration (minutes to hours) and relatively low attack frequency (up to eight a day)

Paroxysmal hemicrania has intermediate duration (minutes) and intermediate attack frequency (up to 40 a day)

SUNCT/SUNA has the shortest attack duration (seconds to minutes) and the highest attack frequency (up to 200 a day)

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Literature review current through: Nov 2017. | This topic last updated: May 10, 2017.
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