Trigeminal Autonomic Cephalgias Due to Structural Lesions

Authors: Irene Favier, MD; Jorine A. van Vliet, MD, PhD; Krista I. Roon, MD, PhD; Ron J. W. Witteveen, MD; Jan J. G. M. Verschuuren, MD, PhD; Michel D. Ferrari, MD, PhD; Joost Haan, MD, PhD
Source: ARCH NEUROL/VOL 64, JAN 2007


Trigeminal autonomic cephalgias (TACs) include cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing. Associated structural lesions may be found, but a causal relationship is often difficult to establish. We sought to identify clinical predictors of underlying structural abnormalities by reviewing previously described and new TAC and TAC-like cases associated with a structural lesion. We found that even typical TACs can be caused by an underlying lesion. Clinical warning signs and symptoms are relatively rare. We recommend neuroimaging in all patients with aTACor TAC-like syndrome.
Trigeminal autonomic cephalgias (TACs) are primary headache syndromes characterized by severe short-lasting headaches accompanied by paroxysmal facial autonomic symptoms.1 The group includes cluster headache (CH), paroxysmal hemicranias (PH), and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT).2 By far, CH is the most frequent syndrome and is characterized by attacks of intense periorbital or orbital pain accompanied by ipsilateral autonomic symptoms.3 These attacks may come clustered in periods of several weeks or months, alternating with attack-free periods of months to years (episodic CH) or without such attack-free periods (chronic CH). The pathophysiologic mechanism of TACs is largely unknown; hypothalamic and trigeminovascular mechanisms have been implicated. 4 Although neuroimaging results are usually normal in TACs, associated structural
lesions have been described,5-52 complicating the diagnostic and management process. It is unknown whether and when to perform neuroimaging in patients with TACs. In this article, we sought to identify clinical signs and symptoms predictive of underlying abnormalities. We reviewed the literature and 4 new cases of a TAC or TAC-like syndrome associated with a structural lesion in which symptoms resolved after treatment of the lesion.
Download and read entire article at JAMA.