Skip to main content

Symptomatic Trigeminal Autonomic Cephalalgias

Abstract

Trigeminal autonomic cephalalgias (TACs) are primary headache syndromes that share some clinical features such as a trigeminal distribution of the pain and accompanying ipsilateral autonomic symptoms. By definition, no underlying structural lesion for the phenotype is found. There are, however, many descriptions in the literature of patients with structural lesions causing symptoms that are indistinguishable from those of idiopathic TACs. In this article, we review the recent insights in symptomatic TACs by comparing and categorizing newly published cases. We confirm that symptomatic TACs can have typical phenotypes. It is of crucial importance to identify symptomatic TACs, as the underlying cause will influence treatment and outcome. Our update focuses on when a structural lesion should be sought.

Introduction

Trigeminal autonomic cephalalgias (TACs) are primary headache syndromes that owe their name to the trigeminal distribution of the pain and the accompanying ipsilateral autonomic symptoms, as defined by the International Classification of Headache Disorders (ICHD)-III beta criteria [1]. The most prevalent TAC is cluster headache, but the category also includes rare diseases such as paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA), and hemicrania continua.

It is well known that an underlying structural lesion can lead to TAC symptoms, which cannot easily be differentiated from those of idiopathic TACs [2, 3•]. Recognizing these underlying pathologies is of crucial importance, as they can influence treatment and outcome. Here, we will give an update of recently published cases with an underlying structural lesion and a TAC phenotype.

Methods

In 2009, our group published a comprehensive update of symptomatic TACs, reported until mid-February 2009 [4]. With this report as starting point, we conducted a PubMed search from February 2009 to January 2015 with the following key words: trigeminal autonomic cephalalgia, cluster headache, hemicrania continua, SUNCT, SUNA, paroxysmal hemicrania, secondary, and symptomatic. Only articles written in English were included of which the full text was available. Cases were divided into three categories: probably secondary, possibly secondary, and unknown. Cases were defined as probably secondary when there was a dramatic improvement of the headache after treatment of the underlying lesion. Cases were defined as possibly secondary when the patient was treated but did not become headache free, or was not treated, but where a causal relation was possible based on previous experience with other patients. Efficacy of indomethacin was not considered as treatment response in paroxysmal hemicrania and hemicrania continua, as this is one of the diagnostic criteria and not specifically aiming at an underlying lesion. The category unknown was used for patients in which a causal relation between the phenotype and the lesion was less likely or at least unclear: in most cases, the patient was not treated and a causal relation between the lesion and the TAC was unlikely on anatomical grounds and/or a probable incidental finding.

Results

Cluster Headache

We found 23 cases with a cluster headache-like phenotype in 23 articles [2, 5, 6•, 710, 11•, 1226]. We excluded 3 patients, as they did not fulfil the ICHD-III criteria beta version, all having an attack duration of more than 3 h [18, 23, 25]. We excluded also another patient who did not have a structural lesion [16]. This resulted in 19 patients of whom 12 could be categorized as probably secondary and 7 as possibly secondary (Table 1).

Table 1 Symptomatic cases of cluster headache

Of the 12 cases in the probably secondary category, 5 had a neoplasm [15, 19, 21, 27, 28]: a non-functioning pituitary adenoma, an ipsilateral carotid paraganglioma, an ipsilateral prolactinoma, an ipsilateral glioblastoma multiforme, and an ipsilateral hemangiopericytoma. A vascular cause, a stroke secondary to moyamoya disease, was found in 1 patient [29]. Other patients had an intrasellar arachnoid cyst, maxillary sinusitis (n = 2), compression of the right vertebral artery by fibrosis, sarcoidosis (with a hypothalamic lesion), and obstructive sleep apnoea [8, 10, 11•, 12, 22, 26].

There were seven cases defined as possibly secondary. Multiple sclerosis was found in two, of whom both became pain free under verapamil or prednisone, which are used as prophylactic cluster headache medication and therefore are not strictly aiming at the underlying lesion [2, 21]. Another patient had an internal carotid artery dissection, but the outcome after treatment remained unclear [6•]. Other diagnoses in this category are as follows: recurrent posterior scleritis and a specific meningitis (treated with prednisone), post-operative cluster headache (lens phacoemulsification and intraocular lens implant), an angiomyolipoma, and an ipsilateral macroprolactinoma [5, 7, 15, 20]. The latter two patients responded completely or partly to treatment of the underlying lesion, but only in combination with preventive cluster headache treatment.

Paroxysmal Hemicrania

We identified three cases of paroxysmal hemicrania, of whom all were excluded as they did not fulfil the ICHD-III criteria beta version [27, 30, 31]. The missing criterion in two patients was an unknown response to indomethacin [30, 31], and the third reported bilateral instead of unilateral facial pain [27].

Hemicrania Continua

We identified seven cases [28, 3235] of symptomatic hemicrania continua of whom one was excluded as the patient did not receive indomethacin [28]. We categorized two cases as probably symptomatic, three as possibly symptomatic, and one as unknown (Table 2).

Table 2 Symptomatic cases of hemicrania continua

The underlying lesions in the cases defined as probably symptomatic were a cerebral venous thrombosis and brain metastases of a primary lung adenocarcinoma [33, 35]. Both patients responded to treatment of the underlying cause, and indomethacin could be withdrawn.

In patients defined as possibly symptomatic, the possible causes were post-traumatic and twice post-operative [34]. All received indomethacin as treatment for their hemicrania continua.

One case was classified as unknown. This patient was diagnosed with an orbital pseudotumour, treated with prednisone and indomethacin [32].

SUNCT and SUNA

We found 29 cases of SUNCT and SUNA [3•, 29, 3648] of whom 1 was excluded because of bilateral pain during the attacks [48]. There were 14 cases defined as probably symptomatic, 12 as possibly symptomatic, and 2 as unknown (Table 3).

Table 3 Symptomatic cases of SUNCT/SUNA

Most cases were defined as probably symptomatic SUNCT/SUNA. The cause found in patients with probably symptomatic SUNCT was most often compression of the trigeminal nerve by an artery (8 out of 14), followed by malignancies as a mixed gangliocytoma, an epidermoid tumour, and prolactinomas [3•, 37, 39, 42, 46, 49]. Furthermore, an aneurysm and cavernous sinus dural fistula were found [38, 40]. All patients responded completely to treatment of the underlying cause, which was most often surgery.

Tumours were most often the underlying cause in the category possibly symptomatic SUNCT/SUNA: an ipsilateral prolactinoma (n = 2), an ipsilateral pituitary tumour, a lung adenocarcinoma, and an ipsilateral meningioma [29, 37, 44]. Furthermore, trigeminal nerve compression (n = 4), multiple sclerosis, a mild hypothalamic-pituitary dysfunction by optical nerve hypoplasia, and a viral meningitis were reported. Five patients became pain free under preventive SUNCT treatment [3•, 36, 43, 47, 49].

There were two cases categorized as unknown. One patient developed a varicella zoster virus meningoencephalitis 1 week after the SUNCT attacks and died within several weeks from arrhythmia secondary to myocarditis, likely as consequence of the viremia [41]. In the other patient, a small posterior skull and a cerebellar hypoplasia, without dysplasia, were found. A causal relation between the development of SUNCT and this anomaly is uncertain [45].

Conclusion

The goal of this review was to give an update on underlying structural lesions associated with TACs, published between February 2009 (since the last review) and January 2015. We identified 53 typical cases: 19 cases with cluster headache, no cases with paroxysmal hemicrania, 6 cases with hemicrania continua, and 28 cases with SUNCT/SUNA.

Tumours were reported in 16 of the 53 cases diagnosed with a TAC, mainly pituitary tumours. Prolactinomas were found in 2 cluster headache and 4 SUNCT patients, followed by pituitary adenomas (n = 2). It has indeed been reported that pituitary tumours account for a large portion of the secondary causes of SUNCT [50]. The other way around, various types of headache including TACs have been reported as a frequent symptom of pituitary tumours [51]. An association between the side of the tumour and side of the headache has been suggested [52••]. In most of the reported cases of secondary SUNCT and secondary cluster headache, surgery or medical treatment of the pituitary tumour resulted in improvement.

A vascular lesion as an underlying cause was less often found. An intracranial or extracranial dissection was reported in only 1 of the 19 cluster headache patients. This patient was diagnosed with cluster headache several years before he experienced a cluster headache attack with prolonged duration, which was probably caused by a carotid dissection [6•]. Dissection as a cause for cluster headache is rare but has been reported in earlier reviews [4, 50]. Recognition is of crucial importance as it can have serious consequences for patients. Cases with carotid dissection have shown improvement of the headache after antiaggregant or anticoagulant therapy. Most patients did not even need preventive cluster headache treatment. Repeated contrast-enhanced magnetic resonance imaging (MRI) should be considered if the characteristics of the headache attacks change over time.

In 12 SUNCT patients, a trigeminal nerve compression by vascular structures as possible cause of SUNCT was found. Eight of 11 surgically treated patients became headache free, whereas only 3 patients had no benefit of the procedure. This is an important finding as SUNCT is often considered medically intractable. Trigeminal nerve compression was found in 42.8 % of this series.

A sinusitis was considered probably causal in 2 cluster headache patients. Sinusitis is a common misdiagnosis in cluster headache. Lainez et al. showed that 14 of 75 cluster headache patients (18.7 %) were initially misdiagnosed as having a sinusitis [53••]. It is sometimes very difficult to make a clear distinction between sinusitis and a TAC [54].

In summary, we found 53 typical cases of secondary TACs in our literature study covering the period from February 2009 to January 2015. Secondary underlying lesions seem to be rare in TACs. However, physicians should be aware of possible underlying pathology, as, for example, prolactinomas or glioblastomas, arteriovenous malformations, dissections, and various inflammations can cause a TAC-like phenotype. In our opinion, not only a contrast-enhanced cerebral MRI should be considered once in every patient to exclude a causal underlying pathology but also imaging of cervical vascular structures.

Most of our findings are in accordance with those of Wilbrink et al. [4]. Of additional importance is the more recent observation that in more than 40 % of patients with SUNCT/SUNA, a trigeminal nerve compression by the superior or inferior cerebellar artery was present and that most of these patients experienced spectacular improvement of their headache after surgical decompression. In contrast to other reviews, we found less frequently an intracranial or extracranial dissection causing cluster headache [4, 50]. This could be explained by the fact that there are already various case reports about intracranial and extracranial dissections causing cluster headache [5557]. The importance of a cerebral MRI to exclude underlying lesions is shown in the current review, as cerebral lesions (e.g. pituitary tumours) were associated with TACs.

Abbreviations

TACs:

Trigeminal autonomic cephalalgias

ICHD:

International Classification of Headache Disorders

SUNCT:

Short-lasting unilateral neuralgiform headache with conjunctival tearing

SUNA:

Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms

MRI:

Magnetic resonance imaging

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. The International Classification of Headache Disorders, 3rd edition (beta version) Cephalalgia 2013;33(9):629–808

  2. Donat J. A patient with cluster headache—due to a brainstem lesion. Headache. 2012;52(6):1035–6.

    PubMed  Article  Google Scholar 

  3. Williams M, Bazina R, Tan L, Rice H, Broadley SA. Microvascular decompression of the trigeminal nerve in the treatment of SUNCT and SUNA. J Neurol Neurosurg Psychiatry. 2010;81(9):992–6. This article shows several cases of compression of the trigeminal nerve as an underlying cause of SUNCT and SUNA.

    PubMed  Article  Google Scholar 

  4. Wilbrink LA, Ferrari MD, Kruit MC, Haan J. Neuroimaging in trigeminal autonomic cephalgias: when, how, and of what? Curr Opin Neurol. 2009;22(3):247–53.

    PubMed  Article  Google Scholar 

  5. Benitez-Rosario MA, McDarby G, Doyle R, Fabby C. Chronic cluster-like headache secondary to prolactinoma: uncommon cephalalgia in association with brain tumors. J Pain Symptom Manage. 2009;37(2):271–6.

    PubMed  Article  Google Scholar 

  6. Candeloro E, Canavero I, Maurelli M, Cavallini A, Ghiotto N, Vitali P, et al. Carotid dissection mimicking a new attack of cluster headache. J Headache Pain. 2013;14:84. This case report describes a carotid dissection with the phenotype of a prolonged cluster headache attack.

    PubMed Central  PubMed  Article  Google Scholar 

  7. Choi JY, Kim YH, Oh K, Yu SW, Jung KY, Kim BJ. Cluster-like headache caused by posterior scleritis. Cephalalgia. 2009;29(8):906–8.

    PubMed  Article  Google Scholar 

  8. Creac’h C, Duthel R, Barral F, Nuti C, Navez M, Demarquay G, et al. Positional cluster-like headache. A case report of a neurovascular compression between the third cervical root and the vertebral artery. Cephalalgia. 2010;30(12):1509–13.

    PubMed  Article  Google Scholar 

  9. Edvardsson B, Persson S. Cluster headache and parietal glioblastoma multiforme. Neurologist. 2012;18(4):206–7.

    PubMed  Article  Google Scholar 

  10. Edvardsson B, Persson S. Cluster headache and arachnoid cyst. Springerplus. 2013;2(1):4.

    PubMed Central  PubMed  Article  Google Scholar 

  11. Edvardsson B. Cluster headache associated with acute maxillary sinusitis. Springerplus. 2013;2:509. This case report describes the first patient with sinusitis as secondary cause of cluster headache.

    PubMed Central  PubMed  Article  Google Scholar 

  12. Edvardsson B, Persson S. Cluster headache and acute maxillary sinusitis. Acta Neurol Belg. 2013;113(4):535–6.

    PubMed  Article  Google Scholar 

  13. Edvardsson B. Cluster headache associated with a clinically non-functioning pituitary adenoma: a case report. J Med Case Rep. 2014;8:451.

    PubMed Central  PubMed  Article  Google Scholar 

  14. Fontaine D, Almairac F, Mondot L, Lanteri-Minet M. Cluster-like headache secondary to parasagittal hemangiopericytoma. Headache. 2013;53(9):1496–8.

    PubMed  Google Scholar 

  15. Gil-Gouveia R, Fonseca A. Cluster headache after cataract surgery. Clin J Pain. 2013;29(11):e19–21.

    PubMed  Article  Google Scholar 

  16. Grosberg BM, Vollbracht S, Robbins MS, Lipton RB. Cluster headache associated with a sixth nerve palsy: a case report. Cephalalgia. 2011;31(1):122–5.

    PubMed  Article  Google Scholar 

  17. Levy MJ, Robertson I, Howlett TA. Cluster headache secondary to macroprolactinoma with ipsilateral cavernous sinus invasion. Case Rep Neurol Med. 2012;2012:830469.

    CAS  PubMed Central  PubMed  Google Scholar 

  18. Liu KT, Su CS. Cluster-like headache as an opening symptom of cervical spinal epidural abscess. Am J Emerg Med. 2009;27(3):370.

    PubMed  Article  Google Scholar 

  19. Malissart P, Ducros A, Labauge P, De Champfleur NM, Carra-Dalliere C. Carotid paraganglioma mimicking a cluster headache. Cephalalgia. 2014;34(13):1111.

    PubMed  Article  Google Scholar 

  20. Messina G, Rizzi M, Cordella R, Caraceni A, Zecca E, Bussone G, et al. Secondary chronic cluster headache treated by posterior hypothalamic deep brain stimulation: first reported case. Cephalalgia. 2013;33(2):136–8.

    PubMed  Article  Google Scholar 

  21. Mijajlovic MD, Aleksic VM, Covickovic Sternic NM. Cluster headache as a first manifestation of multiple sclerosis: case report and literature review. Neuropsychiatr Dis Treat. 2014;10:2269–74.

    PubMed Central  PubMed  Article  Google Scholar 

  22. Ranieri AL, Tufik S, de Siqueira JT. Refractory cluster headache in a patient with bruxism and obstructive sleep apnea: a case report. Sleep Breath. 2009;13(4):429–33.

    PubMed  Article  Google Scholar 

  23. Robbins MS, Tarshish S, Napchan U, Grosberg BM. Images from headache: atypical cluster headache secondary to giant meningioma. Headache. 2009;49(7):1052–3.

    PubMed  Article  Google Scholar 

  24. Sewell RA, Johnson DJ, Fellows DW. Cluster headache associated with moyamoya. J Headache Pain. 2009;10(1):65–7.

    PubMed Central  PubMed  Article  Google Scholar 

  25. Tsivgoulis G, Mantatzis M, Vadikolias K, Heliopoulos I, Charalampopoulos K, Mitsoglou A, et al. Internal carotid artery dissection presenting as new-onset cluster headache. Neurol Sci. 2013;34(7):1251–2.

    PubMed  Article  Google Scholar 

  26. van der Vlist SH, Hummelink BJ, Westerga J, Boogerd W. Cluster-like headache and a cystic hypothalamic tumour as first presentation of sarcoidosis. Cephalalgia. 2013;33(6):421–4.

    PubMed  Article  Google Scholar 

  27. Porporatti AL, Costa YM, Bonjardim LR, Stuginski-Barbosa J, Conti PC, Martori AH. The coexistence of paroxysmal hemicrania and temporomandibular disorder: importance of multidisciplinary approach. Indian J Dent Res. 2014;25(1):119–21.

    PubMed  Article  Google Scholar 

  28. Kim KS, Yang HS. A possible case of symptomatic hemicrania continua from an osteoid osteoma of the ethmoid sinus. Cephalalgia. 2010;30(2):242–8.

    CAS  PubMed  Google Scholar 

  29. Cascella C, Rosen JB, Robbins MS, Levin M. Resident and fellow section. Teaching case: symptomatic SUNCT. Headache. 2011;51(6):1022–6.

    PubMed  Article  Google Scholar 

  30. Beams JL, Rozen TD. Paroxysmal hemicrania as the clinical presentation of giant cell arteritis. Clin Pract. 2011;1(4), e111.

    PubMed Central  PubMed  Article  Google Scholar 

  31. Dafer RM, Hocker S, Kumar R, McGee J, Jay WM. Resolution of paroxysmal hemicrania after resection of intracranial meningioma. Semin Ophthalmol. 2010;25(1–2):34–5.

    PubMed  Article  Google Scholar 

  32. DeLange JM, Robertson CE, Krecke KN, Garza I. A case report of hemicrania continua-like headache due to ipsilateral inflammatory orbital pseudotumor. Headache. 2014;54(9):1541–2.

    PubMed  Article  Google Scholar 

  33. Mathew T, Badachi S, Sarma GR, Nadig R. Cerebral venous thrombosis masquerading as hemicrania continua. Neurol India. 2014;62(5):556–7.

    PubMed  Article  Google Scholar 

  34. Prakash S, Shah ND, Soni RK. Secondary hemicrania continua: case reports and a literature review. J Neurol Sci. 2009;280(1–2):29–34.

    PubMed  Article  Google Scholar 

  35. Robbins MS, Grosberg BM. Hemicrania continua-like headache from metastatic lung cancer. Headache. 2010;50(6):1055–6.

    PubMed  Article  Google Scholar 

  36. Bogorad I, Blum S, Green M. A case of MS presenting with SUNCT status. Headache. 2010;50(1):141–3.

    PubMed  Article  Google Scholar 

  37. Chitsantikul P, Becker WJ. SUNCT, SUNA and pituitary tumors: clinical characteristics and treatment. Cephalalgia. 2013;33(3):160–70.

    PubMed  Article  Google Scholar 

  38. Coven I, Coban G, Koyuncu G, Ilik KM. SUNCT syndrome findings accompanied by cavernous segment aneurysm. Clin Neurol Neurosurg. 2013;115(6):781–3.

    PubMed  Article  Google Scholar 

  39. de Lourdes FM, Bruera O, Pozzo MJ, Leston J. SUNCT syndrome responding absolutely to steroids in two cases with different etiologies. J Headache Pain. 2009;10(1):55–7.

    Article  Google Scholar 

  40. Domingos J, Pereira PJ, Roriz MJ, Xavier AJ, Magalhaes M, Monteiro PJ. Cavernous sinus dural fistula ‘mimicking’ SUNCT. Cephalalgia. 2012;32(3):263–4.

    PubMed  Article  Google Scholar 

  41. Granato A, Belluzzo M, Fantini J, Zorzon M, Koscica N. SUNCT-like syndrome attributed to varicella-zoster virus meningoencephalitis. Neurol Sci 2014.

  42. Guerreiro R, Casimiro M, Lopes D, Marques JP, Fontoura P. Video NeuroImage: symptomatic SUNCT syndrome cured after trigeminal neurovascular contact surgical decompression. Neurology. 2009;72(7), e37.

    CAS  PubMed  Article  Google Scholar 

  43. Ito Y, Yamamoto T, Ninomiya M, Mizoi Y, Itokawa K, Tamura N, et al. Secondary SUNCT syndrome caused by viral meningitis. J Neurol. 2009;256(4):667–8.

    PubMed  Article  Google Scholar 

  44. Kutschenko A, Liebetanz D. Meningioma causing gabapentin-responsive secondary SUNCT syndrome. J Headache Pain. 2010;11(4):359–61.

    PubMed Central  PubMed  Article  Google Scholar 

  45. Panconesi A, Bartolozzi ML, Guidi L. SUNCT syndrome or first division trigeminal neuralgia associated with cerebellar hypoplasia. J Headache Pain. 2009;10(6):461–4.

    PubMed Central  PubMed  Article  Google Scholar 

  46. Rodgers SD, Marascalchi BJ, Strom RG, Huang PP. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome secondary to an epidermoid tumor in the cerebellopontine angle. Neurosurg Focus. 2013;34(3), E1.

    PubMed  Article  Google Scholar 

  47. Theeler BJ, Joseph KR. SUNCT and optic nerve hypoplasia. J Headache Pain. 2009;10(5):381–4.

    PubMed Central  PubMed  Article  Google Scholar 

  48. Zidverc-Trajkovic J, Vujovic S, Sundic A, Radojicic A, Sternic N. Bilateral SUNCT-like headache in a patient with prolactinoma responsive to lamotrigine. J Headache Pain. 2009;10(6):469–72.

    PubMed Central  PubMed  Article  Google Scholar 

  49. Favoni V, Grimaldi D, Pierangeli G, Cortelli P, Cevoli S. SUNCT/SUNA and neurovascular compression: new cases and critical literature review. Cephalalgia. 2013;33(16):1337–48.

    PubMed  Article  Google Scholar 

  50. Cittadini E, Matharu MS. Symptomatic trigeminal autonomic cephalalgias. Neurologist. 2009;15(6):305–12.

    PubMed  Article  Google Scholar 

  51. Wang SJ, Hung CW, Fuh JL, Lirng JF, Hwu CM. Cranial autonomic symptoms in patients with pituitary adenoma presenting with headaches. Acta Neurol Taiwan. 2009;18(2):104–12.

    PubMed  Google Scholar 

  52. Kallestrup MM, Kasch H, Osterby T, Nielsen E, Jensen TS, Jorgensen JO. Prolactinoma-associated headache and dopamine agonist treatment. Cephalalgia. 2013;34(7):493–502. This case series gives an overview about the symptoms of prolactinoma-associated headache and the effect of dopamine agonist treatment.

    PubMed  Article  Google Scholar 

  53. Sanchez Del RM, Leira R, Pozo-Rosich P, Lainez JM, Alvarez R, Pascual J. Errors in recognition and management are still frequent in patients with cluster headache. Eur Neurol. 2014;72(3–4):209–12. This article gives an overview about common misdiagnosis in cluster headache.

    Article  Google Scholar 

  54. Pong DL, Marom T, Pine HS. Short-lasting unilateral neuralgiform headache attacks with conjunctiva injection and tearing presenting as sphenoiditis. Am J Otolaryngol. 2013;34(2):166–8.

    PubMed  Article  Google Scholar 

  55. Godeiro-Junior C, Kuster GW, Felicio AC, Porto Jr PP, Pieri A, Coelho FM. Internal carotid artery dissection presenting as cluster headache. Arq Neuropsiquiatr. 2008;66(3B):763–4.

    PubMed  Article  Google Scholar 

  56. Rigamonti A, Iurlaro S, Zelioli A, Agostoni E. Two symptomatic cases of cluster headache associated with internal carotid artery dissection. Neurol Sci. 2007;28 Suppl 2:S229–31.

    PubMed  Article  Google Scholar 

  57. Straube A, Freilinger T, Ruther T, Padovan C. Two cases of symptomatic cluster-like headache suggest the importance of sympathetic/parasympathetic balance. Cephalalgia. 2007;27(9):1069–73.

    CAS  PubMed  Article  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Ilse F. de Coo reports support for a conference visit from Electrocore.

Leopoldine A Wilbrink received consultancy/industry support from Medtronic, Menarini, Allergan, Neurocore, and independent support from Fonds Nuts Ohra.

Joost Haan declares that he has no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ilse F. de Coo.

Additional information

This article is part of the Topical Collection on Secondary Headache

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

de Coo, I.F., Wilbrink, L.A. & Haan, J. Symptomatic Trigeminal Autonomic Cephalalgias. Curr Pain Headache Rep 19, 39 (2015). https://doi.org/10.1007/s11916-015-0514-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-015-0514-z

Keywords

  • Cluster headache
  • Trigeminal autonomic cephalalgia
  • Paroxysmal hemicrania
  • Hemicrania continua
  • Short-lasting unilateral neuralgiform headache with conjunctival tearing
  • Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms