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How Are Trigeminal Autonomic Cephalgias Headaches Treated?
One of the most important nerves in the face is the trigeminal nerve, and perhaps because of this, the rare conditions that affect it can sometimes be debilitatingly painful.
Whilst not the most common condition, the most well-known of these is trigeminal neuralgia, also known as Fothergill disease, in no small part due to its reputation as one of the most painful conditions known to the medical world.
However, it is not the only condition to affect the trigeminal nerve, which controls chewing and provides sensation to significant parts of the face, and many conditions relating to the nerve are grouped together under the collective term trigeminal autonomic cephalgia (TAC).
What is a TAC, why can they be difficult to diagnose, and how are they treated once they are?
There are five recognised TACs, all of which typically affect one side of the head around the eye. They can cause intense pain and symptoms like:
Cluster Headaches
Among these TACs, cluster headaches are the most common, characterised by recurrent stabbing headaches lasting up to three hours. These headaches are linked to the trigeminal nerve, which controls facial sensation and is responsible for the intense pain and associated symptoms.
As a condition, they are most similar to trigeminal neuralgia and can be debilitating at times.
Paroxysmal Hemicrania
Another TAC is paroxysmal hemicrania, which tends to have similar pain symptoms, but the pain attacks tend to be shorter but far more common. The pain lasts for up to 30 minutes, but up to 50 episodes of pain per day have been reported, although the average is closer to ten.
This makes them hard to treat using medication as the attacks are so brief.
SUNCT/SUNA
There are also two short-lasting TAC conditions, known as short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA).
Some SUNCT headaches can last as little as six seconds but can happen up to 200 times in a day.
Hemicrania Continua
As well as these, there is hemicrania continua, which unlike other forms of TAC tends to manifest not as sudden sharp episodes of pain but as a constant dull pain that can sometimes spike severely, with some pain spells lasting up to three days.
Headache conditions can often be confused with migraines, which are far more common but can typically be treated with nonsteroidal anti-inflammatory drugs such as ibuprofen in a way that TACs cannot.
The main ways in which TACs are diagnosed is if the pain does not go away with the help of painkillers, the headaches frequently return, they are so painful that they lead to restlessness and agitation, and there are other connecting symptoms like drooping eyelids.
Both SUNCT and SUNA can be easier to diagnose because of how frequently and quickly the pain episodes appear and disappear.
One way in which different TACs can be diagnosed is with the use of indometacin, an anti-inflammatory medication that is very effective at treating paroxysmal hemicrania and to a lesser degree hemicrania continua but not cluster headaches.
Another way to determine cluster headaches apart from other TACs is predictability; cluster headaches are linked to a person’s body clock, following a 24-hour pattern which can in some cases be predicted to the exact minute.
For paroxysmal hemicrania, indometacin is a medicine used for both diagnosis and treatment, as it can help significantly with symptoms, but other types of TACs are treated with a wider range of interventions, including medication and radiosurgery.
Alternatives include triptans, oxygen therapy, steroid injections and the use of medicines such as verapamil in order to help prevent or reduce cluster headache attacks.
TACs can be managed and in many cases treated, but the biggest hurdle is knowing the cause in the first place.
Whilst not the most common condition, the most well-known of these is trigeminal neuralgia, also known as Fothergill disease, in no small part due to its reputation as one of the most painful conditions known to the medical world.
However, it is not the only condition to affect the trigeminal nerve, which controls chewing and provides sensation to significant parts of the face, and many conditions relating to the nerve are grouped together under the collective term trigeminal autonomic cephalgia (TAC).
What is a TAC, why can they be difficult to diagnose, and how are they treated once they are?
What Are Trigeminal Autonomic Cephalgia?
Unlike trigeminal neuralgia, which is a singular disorder with a singular cause, a TAC is one of a group of rare headache disorders that have some shared features and a connected root cause but can have very different symptoms.There are five recognised TACs, all of which typically affect one side of the head around the eye. They can cause intense pain and symptoms like:
- Severe, one-sided head pain
- Watering eyes
- Drooping eyelids
- Redness around the eyes
Cluster Headaches
Among these TACs, cluster headaches are the most common, characterised by recurrent stabbing headaches lasting up to three hours. These headaches are linked to the trigeminal nerve, which controls facial sensation and is responsible for the intense pain and associated symptoms.
As a condition, they are most similar to trigeminal neuralgia and can be debilitating at times.
Paroxysmal Hemicrania
Another TAC is paroxysmal hemicrania, which tends to have similar pain symptoms, but the pain attacks tend to be shorter but far more common. The pain lasts for up to 30 minutes, but up to 50 episodes of pain per day have been reported, although the average is closer to ten.
This makes them hard to treat using medication as the attacks are so brief.
SUNCT/SUNA
There are also two short-lasting TAC conditions, known as short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA).
Some SUNCT headaches can last as little as six seconds but can happen up to 200 times in a day.
Hemicrania Continua
As well as these, there is hemicrania continua, which unlike other forms of TAC tends to manifest not as sudden sharp episodes of pain but as a constant dull pain that can sometimes spike severely, with some pain spells lasting up to three days.
How Are Trigeminal Autonomic Cephalgias Diagnosed And Treated?
Because all TACs are rare, with even cluster headaches only affecting one out of 1,000 people and hemicrania continua being so rare as to be impossible to estimate, a major part of the treatment process is the correct diagnosis.Headache conditions can often be confused with migraines, which are far more common but can typically be treated with nonsteroidal anti-inflammatory drugs such as ibuprofen in a way that TACs cannot.
The main ways in which TACs are diagnosed is if the pain does not go away with the help of painkillers, the headaches frequently return, they are so painful that they lead to restlessness and agitation, and there are other connecting symptoms like drooping eyelids.
Both SUNCT and SUNA can be easier to diagnose because of how frequently and quickly the pain episodes appear and disappear.
One way in which different TACs can be diagnosed is with the use of indometacin, an anti-inflammatory medication that is very effective at treating paroxysmal hemicrania and to a lesser degree hemicrania continua but not cluster headaches.
Another way to determine cluster headaches apart from other TACs is predictability; cluster headaches are linked to a person’s body clock, following a 24-hour pattern which can in some cases be predicted to the exact minute.
For paroxysmal hemicrania, indometacin is a medicine used for both diagnosis and treatment, as it can help significantly with symptoms, but other types of TACs are treated with a wider range of interventions, including medication and radiosurgery.
Alternatives include triptans, oxygen therapy, steroid injections and the use of medicines such as verapamil in order to help prevent or reduce cluster headache attacks.
TACs can be managed and in many cases treated, but the biggest hurdle is knowing the cause in the first place.
