Cluster Headache Paroxysml Hemicrania Continuous Hemicrania SUNCT/SUNA

1. TRIGEMINAL AUTONOMIC
CEPHALALGIAS
Goadsby, P. J. (2012). Trigeminal autonomic cephalalgias. CONTINUUM: Lifelong Learning in
Neurology, 18(4, Headache), 883-89
Summarized by: Ade Wijaya, MD
November 2017

2. CLASSIFICATION
 Cluster headache
 Paroxysmal hemicrania
 Short-lasting unilateral neuralgiform headache
attacks with conjunctival injection and tearing
(SUNCT)/short-lasting unilateral neuralgiform
headache attacks with cranial autonomic features
(SUNA)
 Hemicrania continua

3. DIFFERENTIAL DIAGNOSIS

4. PATHOPHYSIOLOGY

5. CLUSTER HEADACHE

6. CLUSTER HEADACHE

7. CLUSTER HEADACHE
Acute treatment:
 100% oxygen at 12 L/min to 15 L/min for 15 to 20
minutes
 Sumatriptan injection (6 mg)
 Sumatriptan 20 mg and zolmitriptan 5 mg nasal sprays

9. SUNCT/SUNA

10. SUNCT/SUNA
Treatment:
 Lamotrigine
 Topiramate, gabapentin
 IV lidocaine

11. HEMICRANIA CONTINUA
 Lasting, waxing-waning, without resolution
 Maybe accompanied by ipsilateral autonomic
symptoms
 Complete & dramatic response to indomethacin

12. HEMICRANIA CONTINUA
Clinical diagnosis
 Does not change sides
 Ipsilateral autonomic symptoms with ptosis/miosis
 Indomethacin response

13. HEMICRANIA CONTINUA
Treatment
 Indomethacin
 Alternative:
- Topiramate
- Greater occipital nerve injection with lidocaine and
methylprednisolone
- Occipital nerve stimulation