Chapter 015. Headache (Part 14)

Table Cephalalgias15-8ClinicalFeaturesoftheTrigeminalAutonomicCluster HeadacheParoxysmal HemicraniaSUNCTGenderMFF=MF~MPainType boringStabbing,Throbbing, boring, stabbingBurning, stabbing, sharpSeverityExcruciatingExcruciatingSevere excruciatingtoSiteOrbit, templeOrbit, templePeriorbitalAttack frequency1/alternate day– 8/d1–40/d (5/d for more than half the time)3–200/dDuration attackof15–180 min2–30 min5–240 sAutonomic featuresYesYesYes (prominent conjunctival injection lacrimation)a andMigrainous featuresbYesYesYesAlcohol triggerYesNoNoCutaneous triggersNoNoYesIndomethaci n effect—Yesc—Abortive treatmentSumatriptanNo effective (IV)Lidocaineinjection or nasal treatment sprayOxygenProphylactic treatmentVerapamil n MethysergidIndomethaci eLamotrigineTopiramateLithiumGabapentin ...
Nội dung trích xuất từ tài liệu:
Chapter 015. Headache (Part 14) Chapter 015. Headache (Part 14) Table 15-8 Clinical Features of the Trigeminal AutonomicCephalalgias Cluster Paroxysmal SUNCT Headache Hemicrania Gender M>F F=M F~M Pain Type Stabbing, Throbbing, Burning, boring boring, stabbing stabbing, sharp Severity Excruciating Excruciating Severe to excruciating Site Orbit, temple Orbit, temple Periorbital Attack 1/alternate 1–40/d (>5/d 3–200/dfrequency day– 8/d for more than half the time) Duration of 15–180 min 2–30 min 5–240 sattack Autonomic Yes Yes Yesfeatures (prominent conjunctival injection and lacrimation)a Migrainous Yes Yes Yesfeaturesb Alcohol Yes No Notrigger Cutaneous No No Yestriggers Indomethaci — Yesc —n effect Abortive Sumatriptan No effective Lidocainetreatment injection or nasal treatment (IV) spray Oxygen Prophylactic Verapamil Indomethaci Lamotrigintreatment n e Methysergid e Topiramate Lithium Gabapentin a If conjunctival injection and tearing not present, consider SUNA. b Nausea, photophobia, or phonophobia; photophobia and phonophobia aretypically unilateral on the side of the pain. c Indicates complete response to indomethacin. Note: SUNCT, short-lasting unilateral neuralgiform headache attacks withconjunctival injection and tearing TACs must be differentiated from short-lasting headaches that do not haveprominent cranial autonomic syndromes, notably trigeminal neuralgia, primarystabbing headache, and hypnic headache. The cycling pattern and length,frequency, and timing of attacks are useful in classifying patients. Patients withTACs should undergo pituitary imaging and pituitary function tests as there is anexcess of TAC presentations in patients with pituitary tumor–related headache.