Comparison of Trigeminal Autonomic Cephalalgias: Cluster Headache vs Paroxysmal Hemicrania vs SUNCT and SUNA vs Hemicrania Continua

Cluster headache, paroxysmal hemicrania, SUNCT, SUNA and hemicrania continua compared.

By Cerebral Torque

Published Updated 1 min read

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:ย nonsteroidal anti-inflammatory drugs.

*Conjuctival injection AND lacrimation (tearing) are present.

**Either conjuctival injection OR lacrimation is present, not both.ย 

***Migraine features may include nausea, vomiting, light/noise sensitivity.

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Guided practice

Alternate nostril breathing

A 5-minute guided practice for migraine prevention, from Unraveling Migraine. Captions are built into the video.

  • Prevention, not a rescue. Keep your usual medicine for migraine attacks.
  • Daily practice is what counts. The study behind it used 3 short sessions a day for 3 months.
  • Skip it or stop if your nose is blocked or it starts to feel like a strain.
Read the full guide and the research