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Mechanisms of Cluster Headache and Other Trigeminal Autonomic Cephalalgias

  • Sanjay Prakash
  • Jakob Møller Hansen
Reference work entry

Abstract

The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders characterized by paroxysmal unilateral head pain that occurs in association with ipsilateral cranial autonomic features. The TACs comprises cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA).

The TACs differ in attack duration and frequency as well as the response to therapy. However, there are considerable clinical and therapeutic overlaps among the TACs and it has been hypothesized that all TACs may have a common pathophysiology. Both peripheral and central mechanisms are involved in generation of attacks and trigeminovascular-nociceptive pathways, including trigeminal autonomic reflex are the final pathways for the manifestations of these disorders. The periodicity of TAC attacks, endocrinal abnormalities, and hypothalamic activation suggest that the hypothalamus may play a key role in the pathogenesis of TACs. A number of hypothalamic nuclei and circuits have been suggested for the abnormalities of nociceptive, autonomic, and neuroendocrine functions of TACs, including orexinergic, somatostatinergic, serotoninergic, and opioidergic pathways. The interrelations of these circuits and their relations with the trigeminal autonomic reflex are still to be determined. Dysfunctions in the hypothalamus and its circuits may facilitate inputs on the trigeminovascular system and lead to the various TAC symptoms. Secondary TACs may result from a range of other disorders.

Keywords

Cluster Headache Chronic Cluster Headache Paroxysmal Hemicrania Cluster Headache Patient Occipital Nerve Stimulation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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© Lifting The Burden 2011

Authors and Affiliations

  1. 1.Department of NeurologyMedical College & SSG HospitalBarodaIndia
  2. 2.Danish Headache Centre and Department of NeurologyGlostrup Hospital, University of CopenhagenGlostrupDenmark

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