Trigeminal Autonomic Cephalalgias

This article offers a detailed exploration of Trigeminal Autonomic Cephalalgias (TACs), focusing specifically on paroxysmal hemicrania. It describes the characteristics of paroxysmal hemicrania, including its symptoms, diagnostic criteria, and response to the indomethacin test. The article emphasizes the prophylactic treatment approach due to the short and intense nature of the attacks and discusses various treatment options including indomethacin, NSAIDs, calcium channel blockers, and alternative approaches like nerve blockades and occipital nerve stimulation.

Characteristics of Paroxysmal Hemicrania

Paroxysmal hemicrania, part of the TACs group, is characterized by severe unilateral pain episodes with cranial autonomic features. It requires a brain MRI for diagnosis to rule out structural brain lesions. The indomethacin test is a robust response marker.

Treatment Approaches for Paroxysmal Hemicrania

The primary treatment for paroxysmal hemicrania is prophylactic with indomethacin being the drug of choice. The dosage and duration depend on whether the condition is episodic or chronic. NSAIDs and calcium channel blockers like verapamil may also be helpful. Alternative treatments include local nerve blockades, occipital nerve stimulation, and surgical procedures such as stellate ganglionectomy.

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