Abstract
Trigeminal autonomic cephalalgias (TACs) and hemicrania continua (HC) are relatively rare but clinically rather well-defined primary headaches. Despite the existence of clear-cut diagnostic criteria (The International Classification of Headache Disorders, 2nd edition - ICHD-II) and several therapeutic guidelines, errors in workup and treatment of these conditions are frequent in clinical practice. We set out to review all available published data on mismanagement of TACs and HC patients in order to understand and avoid its causes. The search strategy identified 22 published studies. The most frequent errors described in the management of patients with TACs and HC are: referral to wrong type of specialist, diagnostic delay, misdiagnosis, and the use of treatments without overt indication. Migraine with and without aura, trigeminal neuralgia, sinus infection, dental pain and temporomandibular dysfunction are the disorders most frequently overdiagnosed. Even when the clinical picture is clear-cut, TACs and HC are frequently not recognized and/or mistaken for other disorders, not only by general physicians, dentists and ENT surgeons, but also by neurologists and headache specialists. This seems to be due to limited knowledge of the specific characteristics and variants of these disorders, and it results in the unnecessary prescription of ineffective and sometimes invasive treatments which may have negative consequences for patients. Greater knowledge of and education about these disorders, among both primary care physicians and headache specialists, might contribute to improving the quality of life of TACs and HC patients.
Highlights
The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders that includes cluster headache (CH), paroxysmal hemicrania (PH), and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/cranial autonomic features (SUNCT)
An additional 9 studies [16,19-25] were identified by checking the references of relevant papers and reviews, as well as literature that was known to be relevant by the authors
The data on errors in the diagnosis and treatment of TACs or Hemicrania continua (HC) extracted from the case reports/series and clinical/population studies considered in this review are summarized in Tables 1, 2, 3 and 4
Summary
The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders that includes cluster headache (CH), paroxysmal hemicrania (PH), and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/cranial autonomic features (SUNCT). HC is included in group 4 of The International Classification of Headache Disorders, second edition (ICHD-II) [1]. This categorization is still debated and HC is often included with the TACs [2,3]. The aim of this study was to review all published data, available to us, on mismanagement of TACs and HC, in order to understand its causes and help improve the management of these patients. These findings have been reported in preliminary form (3rd European Headache and Migraine Trust International Congress, London, September 2012)
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