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Clinical features and treatment of the trigeminal autonomic cephalalgias

Clinical features and treatment of the trigeminal autonomic cephalalgias
  Cluster headache Paroxysmal hemicrania SUNCT* and SUNA Hemicrania continua
Sex predominance Male (4:1) No (1:1) Female (1.7:1) Female (2:1)
Pain
Type Stabbing Stabbing or throbbing Stabbing or burning Stabbing, throbbing, burning, or aching
Severity Excruciating Excruciating Severe to excruciating Mild to severe
Site Orbital or temporal Orbital or temporal Orbital or temporal Orbital, frontal, and/or temporal
Typical attack frequency 1 every other day to 8 daily 5 to 40 daily 1 to 200 daily Continuous (with exacerbations)
Duration of attack 15 to 180 minutes 2 to 30 minutes 1 second to 10 minutes Months to years (untreated)
Autonomic features?Δ Yes Yes Yes (conjunctival injection and lacrimation prominent with SUNCT) Yes
Restlessness and/or agitation? Yes Yes Sometimes Yes
Associated migrainous features?◊ Yes Yes Rare Frequent
Triggers Alcohol Stress, exercise, alcohol Tactile stimuli (eg, touching face, shaving, brushing teeth) Alcohol
Indomethacin responsive? No Yes No Yes
Abortive treatment

Triptans (intravenous or nasal)

Oxygen		 None Lidocaine (intravenous) for frequent and debilitating symptoms None
Prophylactic treatment

Verapamil

Glucocorticoids

Galcanezumab

Lithium

Indomethacin

Verapamil

NSAIDs

Lamotrigine

Oxcarbazepine

Topiramate

Gabapentin		 Indomethacin
SUNCT: short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing; SUNA: short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms; NSAIDs: nonsteroidal anti-inflammatory drugs.
* Both conjunctival injection and lacrimation are present.
¶ May have either conjunctival injection or lacrimation but not both.
Δ Cranial autonomic symptoms: conjunctival injection, lacrimation, nasal congestion or rhinorrhea, facial sweating, miosis and/or ptosis, palpebral edema; symptoms are ipsilateral to the headache.
◊ Migraine-like features may include associated nausea, vomiting, photophobia, or phonophobia.
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