So that's migraine and
tension type headaches,
two very important headache
syndromes to understand.
Let's now shift to talk about the
chronic recurrent episodic headaches
And we'll talk about the
Trigeminal Autonomic Cephalalgias.
And let's do so through a case.
This is a 25-year-old man who presents
with new cluster of headaches.
The headaches are described as
orbital and feel like a boring,
pulsating, deep-quality pain that
stays on one side of the head
but switches sides in between
clusters of headaches.
So it's always on one
side within a cluster,
but between the episodes of
clusters can change sides.
The headaches are extremely severe
and have been clustering at night,
keeping the patient awake and
he has not been able to sleep
lasting 30-60 minutes each.
the patient describes autonomic signs
on the same side as the pain.
This includes tearing and
runny nose or rhinorrhea.
On exam, the patient has a
non-focal neurologic exam
but an erect posture is pacing the
room and agitated clearly in pain.
So what type of headache
syndrome is this?
With a number of features that
reinforced that this is an episodic
and chronic recurrent
with episodes that occur
in clusters and clusters
that are separated from one another
episodes of clusters, many would describe.
And here we see prominent
So tearing and runny
nose, which we didn't hear
with our patients with
migraine and tension type.
In addition, the headache is
locked to one side it's unilateral
and a duration
that's 30-60 minutes.
All of these features are pointing us
towards a trigeminal autonomic cephalalgia.
Is this a primary or
secondary headache syndrome?
Well, this is a primary
And in this case,
we can proceed to treatment.
We may consider some
evaluation in selected patients
but we need to move to
treatment for this patient
who really has a very severe
headache syndrome at this time.
So what type of
headache is this?
Is this migraine?
Is this tension type, is this cluster
or is it subarachnoid haemorrhage?
Well, that doesn't sound like
That was thunderclap headache.
And this does not have a
It doesn't have that rapid and severe
onset within 1 minute or 60 seconds.
It's a severe headache, but doesn't
meet the criteria for thunderclap.
It doesn't sound like migraine,
it's chronic and recurrent.
But this patient has
prominent autonomic features,
has a unilateral
side locked headache.
We don't see that unilateralality
locked to one side and migraine
and that really supports a diagnosis of
attack of trigeminal autonomic cephalalgia.
Likewise, tension type doesn't
seem like the right diagnosis here.
Tension type is a chronic
recurrent headache syndrome,
but it is typically bilateral
holocephalic with a band like sensation.
This patient has cluster.
And this is the typical
description of a cluster headache.