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Cluster headache, hemicrania continua and SUNCT — the trigeminal autonomic cephalalgias
The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders characterized by severe unilateral head pain with prominent autonomic features. They include cluster headache, hemicrania continua and SUNCT/SUNA — each with distinct features and treatments.
Kathmandu Neurology Clinic & Cognitive Center
Authored and reviewed by Dr. Jitendra Prasad Yadav (MBBS, MD (Internal Medicine), FICN (Neurology), FCNV, FIHM, NMC 8029). Evidence-based, no fabricated outcomes.
The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders characterized by severe unilateral head pain with prominent autonomic features. They include cluster headache, hemicrania continua and SUNCT/SUNA — each with distinct features and treatments.
Reviewed by Dr. Jitendra Prasad Yadav, MBBS, MD, FICN, FCNV, FIHM — Consultant Neurologist & Headache Specialist (NMC 8029), Kathmandu Neurology Clinic. For evaluation, book an appointment.
TACs share features: severe unilateral head pain, autonomic features (tearing, nasal congestion, ptosis, miosis) on the pain side, and response to specific treatments. They are rare but extremely painful — cluster headache is called 'suicide headache' for its intensity.
Severe orbital/temporal pain lasting 15–180 minutes, occurring in clusters (multiple attacks daily for weeks-months), with autonomic features and restlessness. Acute: oxygen, triptans. Preventive: verapamil, lithium, corticosteroids.
Hemicrania continua: continuous unilateral headache with exacerbations — responds dramatically to indomethacin. SUNCT/SUNA: short-lasting (seconds-minutes) neuralgiform attacks with autonomic features — responds to lamotrigine or gabapentin. Accurate diagnosis is essential for effective treatment.
Goadsby PJ. Pathophysiology of the trigeminal autonomic cephalalgias. Lancet Neurol 2009Content on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.