Semin Neurol 2010; 30(2): 186-191
DOI: 10.1055/s-0030-1249227
© Thieme Medical Publishers

Trigeminal Autonomic Cephalalgias: Paroxysmal Hemicrania, SUNCT/SUNA, and Hemicrania Continua

Peter J. Goadsby1 , 2 , Elisabetta Cittadini2 , Anna S. Cohen2
  • 1Headache Group, Department of Neurology, University of California San Francisco, San Francisco, California
  • 2Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
Further Information

Publication History

Publication Date:
29 March 2010 (online)


The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders that include cluster headache (CH), paroxysmal hemicrania (PH), and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/cranial autonomic features (SUNCT/SUNA). Hemicrania continua (HC) is often included with this group, although the second edition of The International Classification of Headache Disorders did not link the entities. Trigeminal autonomic cephalalgias are generally characterized by relatively short-lasting attacks of severe pain and lateralized associated features including the pain, cranial autonomic symptoms, and where present, migrainous symptoms, such as photophobia. Paroxysmal hemicrania has intermediate duration and intermediate attack frequency. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing has the shortest attack duration and the highest attack frequency. Hemicrania continua has a continuous pain with exacerbations that can include cranial autonomic symptoms as part of the phenotype. The syndromes share much in their pathophysiology and investigation paths; however, their treatment is distinct, so that the accurate differentiation is important for optimal management.


Professor Peter J Goadsby, M.D. 

Headache Group, Department of Neurology, UCSF Headache Center

1701 Divisadero Street, San Francisco, CA 94115