Chapter 015. Headache (Part 14) Table 15-8 Clinical Features of the Trigeminal Autonomic Cephalalgias Cluster Headache Paroxysmal Hemicrania SUNCT Gender M>F F=M F~M Pain Type Stabbing, boring Throbbing, boring, stabbing Burning, stabbing, sharp Severity Excruciating Excruciating Severe to excruciating Site Orbit, temple Orbit, temple Periorbital Attack frequency 1/alternate day– 8/d 1– 40/d (>5/d for more than half the time) 3–200/d Duration of attack 15–180 min 2–30 min 5–240 s Autonomic features Yes Yes Yes (prominent conjunctival injection and lacrimation) a Migrainous features b Yes Yes Yes Alcohol trigger Yes No No Cutaneous triggers No No Yes Indomethaci n effect — Yes c — Abortive treatment Sumatriptan injection o r nasal spray Oxygen No effective treatment Lidocaine (IV) Prophylactic treatment Verapamil Methysergid Indomethaci n Lamotrigin e e Lithium Topiramate Gabapentin a If conjunctival injection and tearing not present, consider SUNA. b Nausea, photophobia, or phonophobia; photophobia and phonophobia are typically unilateral on the side of the pain. c Indicates complete response to indomethacin. Note: SUNCT, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing TACs must be differentiated from short-lasting headaches that do not have prominent cranial autonomic syndromes, notably trigeminal neuralgia, primary stabbing headache, and hypnic headache. The cycling pattern and length, frequency, and timing of attacks are useful in classifying patients. Patients with TACs should undergo pituitary imaging and pituitary function tests as there is an excess of TAC presentations in patients with pituitary tumor–related headache. . Chapter 015. Headache (Part 14) Table 15-8 Clinical Features of the Trigeminal Autonomic Cephalalgias Cluster Headache Paroxysmal Hemicrania SUNCT. SUNCT, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing TACs must be differentiated from short-lasting headaches that do not have prominent cranial. prominent cranial autonomic syndromes, notably trigeminal neuralgia, primary stabbing headache, and hypnic headache. The cycling pattern and length, frequency, and timing of attacks are useful