This document summarizes several types of primary headaches including trigeminal autonomic cephalalgias (TACs). TACs are short-lasting headache attacks associated with cranial autonomic symptoms and include cluster headache, paroxysmal hemicrania, and SUNCT. Cluster headaches are characterized by severe, unilateral pain and periodicity with daily bouts. Paroxysmal hemicrania causes very severe, short-lasting unilateral headaches very frequently and responds well to indomethacin. SUNCT involves severe orbital or temporal pain with stabbing or throbbing quality and cutaneous triggerability of attacks. The document also briefly outlines other primary headache types such as hemicrania continua,

1. PRIMARY
HEADACH
ES

2. TRIGEMINAL AUTONOMIC
CEPHALALGIAS
 Cluster headache, paroxysmal hemicrania, SUNCT.
 Short lasting attacks associated with cranial
autonomic symptoms.
 Severe pain- more than once a day
 Patients with TACs should undergo pituitary imaging
and pituitary function tests.

3. CLUSTER HEADACHE
 Pain- deep, non-fluctuating and explosive
 Core feature- periodicity
 Daily bouts of 1-2 attacks; short duration U/L pain
for 8-10 weeks a year; pain free interval
averages1year.
 Patients move about during attacks- pacing,
rocking or rubbing the head for relief.
 Associated with ipsilateral symptoms of cranial
parasympathetic autonomic activation.
 Photophobia/ phonophobia if present tend to be

5. Treatment of CH
 CH attacks peak rapidly and thus treatment with
quick onset is required.
 100 % oxygen inhalation.
 Sumatriptan 6 mg s/c or 20 mg nasal spray
 Preventive management
Short term- prednisolone/ verapamil
Long term- verapamil/ lithium/ topiramate/
gabapentin.

6. PAROXYSMAL HEMICRANIA
 U/L, very severe pain
 Short lasting attacks (2- 45 mins)
 Very frequent attacks (>5/ day)
 Marked autonomic features I/L to the pain
 Rapid course (< 72 hrs)
 Excellent response to Indomethacin.
 Male: Female ratio- 1:1
 Pain tends to be retroorbital
 Treatment of choice- Indomethacin

7. SUNCT/ SUNA
 Severe, U/L orbital/ temporal pain
 Stabbing/ throbbing in quality.
 3 basic patterns:
single stabs- short lived
groups of stabs
longer attacks ( saw tooth phenomenon)
 Diagnosis
 Cutaneous triggerability of attacks
 Lack of refractory period b/w attacks
 Lack of response to Indomethacin

8.  Secondary/ symptomatic SUNCT
seen in posterior fossa/ pituitary lesions
evaluate with pituitary function tests and a
brain MRI with pituitary views
 Treatment
Abortive- I/V Lidocaine
Preventive- Lamotrigine (200- 400 mg/ day)
Other drugs- Topiramate/ Gabapentin

9. OTHER PRIMARY
HEADACHES
1. HEMICRANIA CONTINUA
moderate and continuous
U/L asso with fluctuations of severe pain
complete resolution with Indomethacin
exacerbation may be asso with autonomic
features
women affected twice as often as men

10. 2. PRIMARY STABBING HEADACHE
stabbing pain confined to head
single/ series of stabs
absence of asso cranial autonomic features
absence of cutaneous triggering of attacks
patterns of regular recurrence at irregular intervals
described as “ ice-pick pain” or “jab and jolts”

11. 3. PRIMARY COUGH HEADACHE
generalized headache
sudden onset; lasts for several minutes
precipitated by coughing
typically older patients
4. PRIMARY EXERTIONAL HEADACHE
features ~ to both cough headache and migraine
precipitated by any form of exercise
B/L, throbbing headache

12. 5. PRIMARY SEX HEADACHE
precipitated by sexual excitement
dull B/L- suddenly becomes intense
reported more often in men
6. PRIMARY THUNDERCLAP HEADACHE
sudden onset of severe headache
absence of any known provocation
should be vigorously investigated with
neuroimaging (CT/ MRI with MR angiography) and
CSF exmntn.

13. 7. HYPNIC HEADACHE
typically begins a few hours after sleep onset
last for 15-30 mins.
moderately severe and generalized
most patients are female
onset usually after age 60
photophobia/ nausea usually absent
major secondary consideration- poorly controlled
HTN.

14. THANK
YOU……