Comparison of Trigeminal Autonomic Cephalalgias: Cluster Headache vs Paroxysmal Hemicrania vs SUNCT and SUNA vs Hemicrania Continua
Posted on August 04 2023,
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| Clinical Features | Cluster Headache | Paroxysmal Hemicrania | SUNCT* & SUNA** | Hemicrania Continua |
|---|---|---|---|---|
| Sex Predominance | Mostly male | Equal male & female | Mostly female | Mostly female |
| Pain Type | Stabbing | Stabbing or pulsating | Stabbing or burning | Varied pain types |
| Pain Severity | Very severe | Very severe | Severe to very severe | Mild to severe |
| Location | Eye or temple | Eye or temple | Eye or temple | Eye, forehead, and/or temple |
| Attack Frequency | 1 every other day to 8 daily | 5 to 40 daily | 1 to 200 daily | Constant with flare ups |
| Attack Duration | 15 mins to 3 hrs | 2 to 30 mins | Seconds to 10 mins | Months to years untreated |
| Autonomic Symptoms? | Yes | Yes | Yes | Yes |
| Agitation? | Yes | Yes | Sometimes | Yes |
| Migraine Features?*** | Yes | Yes | Rarely | Often |
| Triggers | Alcohol | Stress, exercise, alcohol | Touching face | Alcohol |
| Indomethacin Responsive? | No | Yes | No | Yes |
| Acute Treatment | Triptans, oxygen | None | Lidocaine IV for severe | None |
| Preventive Treatment | Verapamil, corticosteroids, galcanezumab, lithium | Indomethacin, verapamil, NSAIDs | Lamotigrine, oxcarbazepine, topiramate, gabapentin | Indomethacin |
SUNCT: Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing
SUNA: Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (Autonomic symptoms: conjunctival injection, tearing, nasal congestion/runny nose, facial sweating, small pupil and/or droopy eyelid, eyelid swelling on affected side).
NSAIDs: nonsteroidal anti-inflammatory drugs.
*Conjuctival injection AND lacrimation (tearing) are present.
**Either conjuctival injection OR lacrimation is present, not both.
***Migraine features may include nausea, vomiting, light/noise sensitivity.
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