Trigeminal Autonomic Cephalgias and Associated Headaches

These are short-duration primary headaches that occur unilaterally with the ipsilateral involvement of prominent cranial autonomic symptoms. These are quite painful and have characteristic recurrent attacks which make them debilitating. Trigeminal Autonomic Cephalgias include a number of headache conditions such as Clusters, Hemicranias, and Unilateral Neuralgiform headache attacks.

Location of pain

Pain is mostly on one side of the head in Trigeminal Autonomic Cephalgias.

Duration of pain

Headache is very short in duration but there are several attacks experienced by an individual. The number ranges from 15 to 20 attacks in a day.

Headache disorders included in Trigeminal Autonomic Cephalgias

The TACs include Cluster Headache, Paroxysmal Hemicranias, Short lasting Unilateral Neuralgiform Headache with Cranial Autonomic Symptoms.

Cluster headache

It is a unilateral headache with circadian periodic rhythmic headache attacks. The pain is usually felt around and behind the eyes. Cluster headache has a long duration and the frequency of attacks is lesser than other headache disorders included in Trigeminal Autonomic Cephalgias


  • Unilateral headache
  • Nausea and vomiting
  • Photophobia and phonophobia
  • Lacrimation


  • For the treatment of Cluster Headaches, the best option is lithium therapy but that needs proper monitoring.
  • Other than that triptans and NSAIDs can be used to help with the pain.

Paroxysmal Hemicranias

These are unilateral headaches, throbbing, and stabbing in character with periorbital pain. The number of attacks is 1 to 40 attacks per day with each attack lasting only 2 minutes to 30 minutes on average. Individuals who have Paroxysmal Hemicranias respond very well to Indomethacin, an NSAID.


  • Redness of eyes
  • Nasal congestion
  • Photophobia and Phonophobia
  • Facial flushing
  • Nausea and Vomiting
  • Neurological symptoms on the opposite side of the body
  • Pain is triggered by movement
  • Responsive to indomethacin


Indomethacin is the treatment of choice and is also used to distinguish it from other headache disorders in Trigeminal Autonomic Cephalgias.

Short-lasting Unilateral Neuralgiform Headache Attacks (SUNCT and SUNA)

It is a primary headache syndrome in which headache is accompanied by ipsilateral Conjunctival tearing, Lacrimation, and Cranial Autonomic symptoms. The pain is throbbing in character and is mostly experienced in areas supplied by the Ophthalmic division of Trigeminal nerve like orbital, periorbital regions, forehead, and temples. Several patients reported an attack triggered by touching the areas innervated by the Ophthalmic division. And episode can be triggered by touching or washing the face, chewing, eating, brushing teeth, or even talking. The attacks last only a few seconds with the symptomatic period lasting a few days to several months occurring once or twice annually. SUNCT is often considered as a Trigeminal Neuralgia variant.


All the symptoms in SUNCT are experienced on the ipsilateral side of the headache:

  • Conjunctival injection and lacrimation
  • Ipsilateral nasal congestion
  • Rhinorrhea
  • Facial flushing and sweating
  • Edematous eyelids and ptosis
  • Nausea and vomiting


  • Lidocaine is given intravenously to abort an attack.
  • Since it is triggered by touching the trigger zones, the patient is advised to avoid any such activity.
  • Trigeminal ganglion compression and thermocoagulation provide complete relief to some people and is an invasive process.

Risk factors

  • Females are more likely to experience from Trigeminal Autonomic Cephalgias.
  • People who have cluster headaches tend to have other disorders included in TACs as well.


  • Ipsilateral cranial autonomic symptoms can confirm the presence of Trigeminal Autonomic Cephalgias.
  • Respond to indomethacin is showed by Hemicranias.
  • SUNCT has ipsilateral conjunctival tearing and is triggered by touching the trigger zones.
  • Cluster headaches occur in circadian rhythms and are considered as most painful headaches.

When to consult the doctor?

If your headache attacks are becoming more frequent and affecting your quality of life consult a doctor for proper diagnosis and treatment.


How are TACs different from Trigeminal Neuralgias?

Trigeminal Neuralgias are mostly known as variants of Trigeminal Autonomic Cephalgias. Their symptoms are almost alike and is very difficult to distinguish between these.

How does all three disorders in TACs differ from eachother?

Paroxysmal Hemicranias respond to Indomethacin, Cluster Headches occur around the same time of the day everyday, SUNCT has attacks lasting the shortest duration of time that is a few seconds.

What is the ultimate treatment for TACs?

Nerve ganglion compression or nerve block is the only treatment but some people show remission of symptoms and some do not show any sort of relief even after the surgery.