WCN 2023 | Treating trigeminal autonomic cephalalgias: a comprehensive overview and challenges

Elizabeth Leroux, MD, FRCP, University of Calgary, Calgary, Canada discusses the range of treatments available for trigeminal autonomic cephalalgias (TAC), addressing associated challenges. TACs are a group of primary headache disorders namely, paroxysmal hemicrania, hemicrania continua, cluster headache and SUNCT. Indomethacin, an NSAID, is crucial for diagnosing and treating paroxysmal hemicrania and hemicrania continua. However, its use is limited by poor tolerance and side effects like gastrointestinal and hypertensive issues. Other anti-inflammatory drugs like naproxen are less effective. Alternatives, including the supplement Boswellia serrata, have shown efficacy in indomethacin-responsive patients. Use of off-label agents is often necessary in attempts to achieve headache control, such as gabapentin and botulinum toxin. SUNCT poses significant challenges as a notoriously refractory condition. Anti-epileptic drugs such as lamotrigine and carbamazepine are often used initially and can be beneficial. Neuromodulation is often used as a last resort for refractory TACs. This interview took place at the World Congress of Neurology (WCN) 2023 in Montreal, Canada.

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