When most people think of headaches, they imagine tension headaches or migraines.
But there is a group of rare headache disorders called Trigeminal Autonomic Cephalalgias (TACs) that can cause some of the most intense and disabling pain known to medicine.
In this article, we’ll explore what Trigeminal Autonomic Cephalalgias are, the different types, how they are diagnosed, and what treatment options are available.
What are Trigeminal Autonomic Cephalalgias?
The term Trigeminal Autonomic Cephalalgias refers to a group of primary headache disorders (meaning they are not caused by another condition) that share two key features:
- Severe, usually one-sided head pain – usually focused around the eye, temple, or forehead.
- Autonomic symptoms – changes controlled by the autonomic nervous system on the same side of the head as the pain. These may include:
- Red or watery eye
- Nasal congestion or runny nose
- Drooping eyelid or small pupil
- Facial sweating or flushing
These headaches are linked to abnormal activity in the trigeminal nerve (responsible for sensation in the face) and brain regions that control pain and autonomic function, such as the hypothalamus.
The Main Types of Trigeminal Autonomic Cephalalgias
1. Cluster Headache
- Known as the “suicide headache” due to its extreme intensity.
- Pain attacks last 15–180 minutes.
- Can occur up to 8 times per day, often in “clusters” lasting weeks to months.
- Commonly wakes sufferers from sleep.
- Often responds well to oxygen therapy.
2. Paroxysmal Hemicrania
- Shorter attacks (2–30 minutes), but can occur dozens of times per day.
- May respond well to a medication called indomethacin.
3. Short-lasting Unilateral Neuralgiform Headache Attacks (SUNCT and SUNA)
- Extremely short-lasting (seconds to minutes), but can occur hundreds of times daily.
- SUNCT: Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing.
- SUNA: Similar attacks, but autonomic symptoms may vary.
4. Hemicrania Continua
- A continuous one-sided headache with periods of worsening pain.
- Like paroxysmal hemicrania, it responds well to indomethacin.
How are Trigeminal Autonomic Cephalalgias Diagnosed?
Because Trigeminal Autonomic Cephalalgias are rare and can resemble migraines, sinus headaches, or neuralgia, diagnosis is often delayed.
A specialist or expert (usually a neurologist or headache clinician) will:
- Take a detailed history of attack duration, frequency, and symptoms.
- Rule out secondary causes with MRI scans.
- Perform a thorough assessment of the cervical spine (neck).
- Look for response to specific medications (like indomethacin in hemicrania types).
Treatment Options
Management depends on the Trigeminal Autonomic Cephalalgias subtype:
Cluster Headache
Acute: high-flow oxygen therapy or injectable triptans.
Preventive: manual therapy (targeted physiotherapy) involving the cervical spine, medications like verapamil, lithium, or neuromodulation techniques.
Paroxysmal Hemicrania & Hemicrania Continua
Manual therapy (targeted physiotherapy) involving the cervical spine, and Indomethacin (an anti-inflammatory medication) are highly effective.
SUNCT/SUNA
- Manual therapy (targeted physiotherapy) involving the cervical spine, medications such as lamotrigine, carbamazepine, or gabapentin may help.
- Some cases require specialist interventions.
Lifestyle modifications (avoiding triggers, good sleep hygiene, reducing alcohol use) and physiotherapy for associated neck dysfunction may also play a role in overall management.
Living with Trigeminal Autonomic Cephalalgias
Trigeminal Autonomic Cephalalgias are rare, but their impact can be life-changing.
The intensity and frequency of pain attacks often cause significant distress, disruption to work, and emotional strain.
The good news is that with the right diagnosis and treatment, many patients experience dramatic relief.
If you or someone you know suffers from severe one-sided headaches with eye or nasal changes, it’s important to seek assessment by a healthcare professional experienced in headache disorders.
Final Thoughts
Trigeminal autonomic cephalalgias are rare, but they represent some of the most severe headache conditions.
Accurate diagnosis is key, as effective treatments exist for each subtype.
If you think your headaches might fit this pattern, book an appointment with our clinic. Our team can help assess your symptoms, guide you through the diagnosis, and work alongside specialists to find the best treatment plan for you.
Written by:
About the author:
Mattias McAndrew, B.PHTY (Hons), APA Member, has been treating headache, migraine, cephalalgia and neuralgia conditions for almost a decade. He has treated thousands of patients suffering from these conditions over that time.
