Headache - The Trigeminal Cephalalgias

Short Lasting Unilateral Neuralgia with Conjunctival Tearing, (SUN CT), Chronic Paroxysmal Hemicrania, Hemicrania Continua and Cluster Headache

A group of primary head ache disorders characterised by severe unilateral (on one side only) orbital or temporal pain associated with a variable combination of cranial autonomic features such as:

  • Ptosis and (drooping of the eyelid)
  • Eyelid Oedema (swollen eyelid)
  • Conjunctival Injection (redness in the eye)
  • Lacrimation (tearing)
  • Facial Flushing
  • Facial Sweating
  • Rhinorrhoea (runny nose)
  • Although the conditions appear similar, they respond differently to medications and are treated using different medication.

Cluster Headaches (CT)

One of the most painful medical conditions, cluster headaches are characterised by sudden onsets of excruciatingly severe unilateral orbital or temporal pain. They occur in recurrent bouts that may last from anything between 15 minutes up to 3 hours, attacks may occur once a day or up to even 8 times a day during a cluster period. This may last for weeks or months, followed by a period of remission. It is associated with one or more of the above symptoms.

Short Lasting Unilateral Neuralgia with Conjunctival Tearing, (SUN CT)

A rare syndrome described as short lived, irregular attacks of throbbing/stabbing unilateral, orbital or temporal pain accompanied by one or more of the symptoms bullet pointed above.

Chronic Paroxysmal Hemicrania (CHP)

Severe multiple bouts of severe unilateral pain usually felt around the eye. Accompanied by one or more of the above bullet pointed symptoms. Attacks are generally more frequent than those of CH and also shorter – lasting from 2 to approximately 30 minutes. CPH responds well to treatment with Indomethacin (a non-steroidal anti-inflammatory drug).

Hemicrania Continua

This disorder refers to continuous unilateral orbital or temporal pain. It shares similar features to CPH such as lacrimation, eye redness, facial sweating etc. and also responds well to Indomethacin

Treatment

Treatment is with specific medications including drugs for nerve pain, (Pregabalin, Gabapentin, Tricyclic antidepressants), and the use of Indomethacin, (an anti-inflammatory medication to which these pain state respond specifically)

The technique of Occipital Nerve Blocks with steroid and Botox and Occipital Nerve Stimulation may be very helpful in intractable cases. This may also be helpful in Migraine.

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