A review of trigeminal autonomic cephalalgias: diagnosis and treatment.

BACKGROUND: The trigeminal autonomic cephalalgias (TACs) include cluster headache, paroxysmal hemicrania and short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing and its close relative short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms. The primary objectives of this review are to highlight what is known about the trigeminal autonomic cephalalgias, looking at clinical headache characteristics, recognised treatments, and interesting new developments in pathogenesis.

METHOD: Literature search was performed using the reference databases Medline, Science Citation Index and the Cochrane Library. The keywords used were 'cluster headache, paroxysmal hemicrania, SUNCT. Papers discovered by this search were reviewed, as were references cited therein.

RESULTS: Cluster headache has the longest attack duration and relatively low attack frequency. Paroxysmal hemicrania has intermediate neuralgiform head attack frequency. Shortlasting unilateral neuralgiform headache attacks with conjunctival injection and tearing have the shortest attack duration and the highest attack frequency.

CONCLUSION: The importance of diagnosing these syndromes resides in their excellent but highly selective response to treatment.