Diagnosis of Trigeminal Autonomic Cephalalgias and Other Primary Headache Disorders

Abstract

The trigeminal autonomic cephalalgias (TACs) and other primary headache disorders are defined by several important characteristics. They are all severe, short-duration headaches. They possibly share a common hypothalamic generator. Workup for posterior fossa or pituitary pathology is warranted before making these diagnoses. Many of the entities in these two groups, with important exceptions, respond to indomethacin. TACs often demonstrate ipsilateral parasympathetic hyperactivity and/or sympathetic hypoactivity. Among the TACs are the indomethacin sensitive paroxysmal hemicranias. The indomethacin insensitive TACs include the extremely rare SUNCT/SUNA and the more common cluster headache. The “other primary headaches” include primary stabbing headaches, cough headache, exertional headaches, and the sexually-related headaches. These generally tend to be indomethacin responsive. The other two headache disorders discussed are hypnic headache and primary thunderclap headache, the latter whose differential diagnosis is vitally important to recognize and exclude before assigning the diagnosis.