Trigeminal autonomic cephalalgias

 Cluster Headache
o Episodic cluster
 Attacks daily during cluster period, periods lasting 1-3 months, followed by
months or years of remission before returning
o Chronic cluster
 More than 1 year without remission, or with remissions lasting less than 1
month
o Attacks STRICTLY unilateral, distinguish from migraine by length (migraine 4 hour
minimum, CH 15-180 min)
o CH attacks have restlessness, migraines have avoidance of movement
o CH can wake patients out of sleep
o Photophobia and phonophobia VERY COMMON, as is nausea
o When happening treat with subQ sumatriptan or nasal sumatriptan, portable oxygen
tank acute treatment
o Prophylaxis, verapamil
o Transitional treatment provided on first visit while preventative initatied
 Paroxysmal hemicrania
 Short unilateral neuralgiform headache with conjunctival injection and tearing/cranial
autonomic symptoms

 Paroxysmal hemicrania

o Get an MRI of the brain with and without gadolinium

o Characteristics
 Multiple daily attacks of UNILATERAL head pain with cranial autonomic features
(ptosis, rhinorrhea)
o Differentiation from CH – the attacks are shorter, 50% of patients will not experience
restlessness like CH, patients may not be awakened from sleep
 PH occurs more often in WOMEN, CH in MEN
o Best marker – excellent response to indomethacin

 SUNCT
o Similar to PH but attacks last 5-240 seconds with up to 200 a day
o REQUIRED autonomic symptoms, while CH and PH only have them sometimes
o Differentiate from Trigeminal neuralgia by absence of triggers, higher frequency of
attacks/day, and presence autonomic

 Cervicogenic headache
o Chronic headache arising from atlanto occipital and upper cervical joints, perceived in
one or more regions of the head or face
o EASY TO CONFUSE!! Combination of UNILATERAL pain, IPSILATERAL diffuse shoulder,
and arm pain with reduced ROM, and pain relieved with anesthetic blockade
 Consider when lack of response from other treatments
o C1-C3 nerves relay pain to nociceptive nucleus of head and neck, trigeminocervical
nucleus (referred pain to occiput and eyes)
o Can cause allodynia in the neck, scalp, shoulder over time
o Have pt stretch neck, feel cervical spine joints,

o Tension type headaches can only have phonophobia OR photophobia