Trigeminal Autonomic Cephalalgias: Beyond the Conventional Treatments

Abstract

The trigeminal autonomic cephalalgias include cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua. While the majority responds to conventional pharmacological treatments, a small but significant proportion of patients are intractable to these treatments. In these cases, alternative choices for these patients include oral and injectable drugs, lesional or resectional surgery, and neurostimulation. The evidence base for conventional treatments is limited, and the evidence for those used beyond convention is more so. At present, the most evidence exists for nerve blocks, deep brain stimulation, occipital nerve stimulation, sphenopalatine ganglion stimulation in chronic cluster headache, and microvascular decompression of the trigeminal nerve in short-lasting unilateral neuralgiform headache attacks.

A Case Report About Cluster‐Tic Syndrome Due to Venous Compression of the Trigeminal Nerve

“…A long‐term success rate, described as at least 50% relief, was achieved in 14 out of 30 initial procedures in 28 patients with chronic cluster headache . Invasive or destructive treatment aimed at the trigeminal nerve, however, has not been an established treatment of cluster headache …”

Evidence-based treatments for cluster headache

“…In some, intolerance and contraindications may further restrict their use. Pizotifen, 89 , 90 levetiracetam, 91 , 92 gabapentin, 93 , 94 baclofen, 95 intranasal capsaicin, 96 and melatonin 97 , 98 have been shown to be effective in small studies and can therefore be considered as a third-line option in refractory patients.…”

Klasehodepine

“…Smerten ved trigeminusnevralgi er imidlertid støtliknende (1 -2 sek), nesten alltid lokalisert i ansiktet (2. eller 3. gren av trigeminus) og ledsages ikke av autonome fenomener (1). Andre trigeminale autonome hodepiner enn klasehodepine forekommer sjelden (20). Man bør allikevel merke seg at både hemicrania continua og paroksysmal hemikrani kan forebygges ved bruk av indometacin, men at tolerabiliteten for slik behandling er dårlig (20).…”

“…Andre trigeminale autonome hodepiner enn klasehodepine forekommer sjelden (20). Man bør allikevel merke seg at både hemicrania continua og paroksysmal hemikrani kan forebygges ved bruk av indometacin, men at tolerabiliteten for slik behandling er dårlig (20).…”