Table 1.
Clinical features of the trigeminal autonomic cephalalgias and first-line treatments
| Cluster headache | Paroxysmal hemicrania | Hemicrania continua | Short-lasting unilateral neuralgiform headache attacks (SUNCT/SUNA) | |
|---|---|---|---|---|
| ICHD-3 beta Code | 3.1 | 3.2 | 3.4 |
3.3 SUNCT 3.3.1 SUNA 3.3.2 |
| Sex (F:M) | 1:5–7 | 1:1 | 2:1 | 1:2 |
|
Pain Type Severity |
Stabbing, boring Severe |
Throbbing, stabbing, boring Moderate–severe |
Throbbing, ache, sharp, pressure Moderate background with severe exacerbations |
Sharp, shooting, burning Severe |
| Duration and frequency | 15–180 mins, 1–8/day | 2–30 mins, 5–40/day | Continuous | 1–600 s, 1–200/day |
| Autonomic features | Yes | Yes | Yes with exacerbations | Yesa |
| Indometacin effect | No | Complete resolution | Complete resolution | No |
| First choice abortive agent |
Injectable or nasal sumatriptan Oxygen |
Nil | Nil | Nil |
| First choice preventative agents |
Verapamil Lithium Topiramate Methysergideb |
Indometacin | Indometacin | Lamotrigine |
SUNCT short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, SUNA short-lasting unilateral neuralgiform headache attacks with autonomic symptoms, ICHD-3 beta International Classification of Headache Disorders 3rd edition Beta version, F female, M male
aSUNCT: both conjunctival injection and tearing; SUNA: only one or neither of conjunctival injection and tearing
bMethysergide is either not available or is due to be withdrawn in several countries