[Headache attacks with ipsilateral autonomic symptoms]

Abstract

Following the new IHS-classification, cluster headache, paroxysmal hemicrania and SUNCT syndrome are included into the classification as trigemino-autonomic cephalgias (TAC's). Clinically, they share strictly halfsided head pain with autonomic symptoms. The headaches often occur during particular sleep stages and are associated with other chronobiologic factors. Broadly the management of TAC's comprises acute and prophylactic treatment. Paroxysmal hemicrania and hemicrana continua have a very robust response to indomethacin. Acute cluster headache attacks can be treated with inhalation of oxygen or serotonin agonists, whereas verapamil is the drug of choice in the prophylactic treatment. This review covers the clinical picture and therapeutic options. Allthough studies following the criteria of evidence based medicine (EBM) are rare, most patients can be treated sufficiently.