WCN 2023 | Diagnostic criteria for trigeminal autonomic cephalalgias

Elizabeth Leroux, MD, FRCP, University of Calgary, Canada, discusses the diagnostic criteria for trigeminal autonomic cephalalgias (TACs) and some of the difficulties in their clinical diagnosis. There is currently no quantitative blood or imaging test to diagnose TACs, with clinical diagnoses based around the unilateral nature of TACs with pain centered on the frontotemporal area, accompanied by autonomic symptoms such as lacrimation, ptosis, and facial swelling. Once the TAC has been diagnosed there are four further subtypes, most common of which is cluster headache, followed by paroxysmal hemicrania, hemicrania continua, and the extremely rare short unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). Each of these subtypes are primarily defined by the duration and frequency of attacks. Precise measurement of the duration, frequency, triggers, and timing of TAC attacks is critical for diagnosis, with patients often asked to keep a headache diary over a period of time. Treatment with indomethacin is finally used to differentiate TAC subtypes by their response to the drug, with paroxysmal hemicrania and hemicrania continua symptoms diminishing significantly with treatment. This interview took place at the World Congress of Neurology (WCN) 2023 in Montreal, Canada.

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