The Treatment of Trigeminal Autonomic Cephalalgias: An Overview

Trigeminal autonomic cephalalgias (TACs) are primary headaches that include cluster headache (CH), paroxysmal hemicrania (PH), and short-lasting unilateral neuralgiform headache attacks (SUNHAs) with conjunctival injection and tearing (SUNCT) or cranial autonomic features (SUNA). Hemicrania continua (HC) is another form that has been ascribed to TACs for clinical and pathophysiological reasons. CH is the most common of these syndromes, even if is still comparatively rare, with a lifetime prevalence of around 1 in 1,000. TACs share many aspects from the pathophysiological standpoint: a hypothalamic activation may be involved in all forms initiating the attacks, but differences in attack duration and frequency, and in extent of treatment response distinguish one from the other. This review focuses on the treatments currently available for these headaches according to the most recent guidelines. Due to the low frequency of most TACs, there are little data from randomized controlled trials; therefore, evidence from simple open studies in small case series or single-case observations is reported. Promising results have been recently obtained with novel modes of drug administration, with invasive pericranial interventions and with different strategies such as neurostimulation. There are also some future treatments being studied at present.