II. Classification
- Long duration
- Trigeminal Autonomic Cephalgia
- Headaches similar to Cluster Headache
- Unilateral trigeminal distribution symptoms with autonomic features
III. Symptoms
- Characteristics
- Unilateral Headache
- Associated symptoms (at least one of the following cluster-like autonomic findings)
- Conjunctival injection or Lacrimation
- Nasal congestion or Rhinorrhea
- Ptosis or Miosis
- Palliative measures
- Responds completely to Indomethacin
IV. Imaging
-
MRI Brain with and without contrast
- Recommended for all Trigeminal Autonomic Cephalalgia including Cluster Headaches
- Obtain even if no other Headache Red Flag present
V. Diagnosis
- Unilateral Headache of moderate or greater severity Headaches for at least 3 months
- At least of the following (ipsilateral to the Headache, other than restlessness)
- Conjunctival injection or Lacrimation
- Nasal congestion or Rhinorrhea
- Eyelid Edema
- Forehead and facial sweating
- Miosis or Ptosis
- Restlessness or Agitation
- Responds to therapeutic doses of Indomethacin
- Indomethacin 150 to 225 in divided doses per day
- Timing
- Remitting
- Remission periods of >24 hours
- Unremitting
- Daily and continuous Headache >1 year without remission periods >24 hours
- Remitting
- References
VI. Differential Diagnosis
- See Cluster Headache