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Mechanisms of Cluster Headache and Other Trigeminal Autonomic Cephalalgias

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Handbook of Headache

Abstract

The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders characterized by paroxysmal unilateral head pain that occurs in association with ipsilateral cranial autonomic features. The TACs comprises cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA).

The TACs differ in attack duration and frequency as well as the response to therapy. However, there are considerable clinical and therapeutic overlaps among the TACs and it has been hypothesized that all TACs may have a common pathophysiology. Both peripheral and central mechanisms are involved in generation of attacks and trigeminovascular-nociceptive pathways, including trigeminal autonomic reflex are the final pathways for the manifestations of these disorders. The periodicity of TAC attacks, endocrinal abnormalities, and hypothalamic activation suggest that the hypothalamus may play a key role in the pathogenesis of TACs. A number of hypothalamic nuclei and circuits have been suggested for the abnormalities of nociceptive, autonomic, and neuroendocrine functions of TACs, including orexinergic, somatostatinergic, serotoninergic, and opioidergic pathways. The interrelations of these circuits and their relations with the trigeminal autonomic reflex are still to be determined. Dysfunctions in the hypothalamus and its circuits may facilitate inputs on the trigeminovascular system and lead to the various TAC symptoms. Secondary TACs may result from a range of other disorders.

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Authors and Affiliations

  1. Department of Neurology, Medical College & SSG Hospital, 390001, Baroda, Gujarat, India

    Dr. Sanjay Prakash

  2. Danish Headache Centre and Department of Neurology, Glostrup Hospital, University of Copenhagen, DK-2600 Glostrup, 2300, Glostrup, Copenhagen, Denmark

    Dr. Jakob Møller Hansen M.D., Ph.D.

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  1. Dr. Sanjay Prakash
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Correspondence to Sanjay Prakash .

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  1. Department of Medical and Molecular Sciences, School of Health Sciences, Sapienza University of Rome, Rome, Italy

    Paolo Martelletti

  2. Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway

    Timothy J. Steiner

  3. Department of Neuroscience, Faculty of Medicine, Imperial College London, London, UK

    Timothy J. Steiner

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Prakash, S., Møller Hansen, J. (2011). Mechanisms of Cluster Headache and Other Trigeminal Autonomic Cephalalgias. In: Martelletti, P., Steiner, T.J. (eds) Handbook of Headache. Springer, Milano. https://doi.org/10.1007/978-88-470-1700-9_24

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  • DOI: https://doi.org/10.1007/978-88-470-1700-9_24

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-1699-6

  • Online ISBN: 978-88-470-1700-9

  • eBook Packages: MedicineReference Module Medicine

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