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Trigeminal Autonomic Cephalalgias

Trigeminal autonomic cephalalgias, also known as TACs, are a group of rare conditions that cause severe headaches and other uncomfortable symptoms. These pain attacks can make your life unpredictable. At Henry Ford Health, you have access to a team of experts who put you back in control.

Types of trigeminal autonomic cephalalgias we treat

There are many types of trigeminal autonomic cephalalgias, including:

  • Cluster headaches: Intense bouts (clusters) of pain behind the eye along with a runny eye or nose and, sometimes, restlessness
  • Hemicrania continua: Days-long headaches along with red, teary eyes; runny nose and a droopy eyelid
  • Paroxysmal hemicrania: Pain attacks behind the eye that may extend to the back of the neck along with nasal congestion and teary eye
  • Short-lasting unilateral neuralgiform headache attacks (SUNHA): Short, sudden episodes of searing or throbbing pain near the eye or temple, sometimes called “ice pick headaches”

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Trigeminal autonomic cephalalgia symptoms

The most common symptoms of trigeminal autonomic cephalalgia are headaches on one side and runny eyes and nose. You may experience:

  • Abnormally high pressure in the eye
  • Agitation
  • High blood pressure
  • Nasal congestion
  • Sense of fullness in one ear
  • Swollen eyelids
  • Unusual facial flushing or sweating

Trigeminal autonomic cephalalgia care at Henry Ford: Why choose us?

Even though trigeminal autonomic cephalalgias are rare, our headache specialists have decades of experience treating them. You receive safe, effective care increasing your chances for more pain-free days. Even if previous therapies have not been successful, we are here for you with additional therapies and support. Meet our headache and facial pain doctors.

Highlights of our program include:

  • Accurate diagnosis: There are no formal tests to confirm or rule out trigeminal autonomic cephalalgias. That’s why it’s important to see trusted specialists. Our experienced team will obtain a complete history and perform a thorough neurologic exam so we can determine which type of trigeminal autonomic cephalalgia you have.
  • Personalized care: At Henry Ford, we design a care plan just for you. Our close attention to your unique needs helps you get the most out of treatments while lowering your risk of complications. We have expertise in managing medications like indomethacin, the most effective treatment option for trigeminal autonomic cephalalgia pain.
  • Timely treatment: For symptom flare-ups, we deliver drugs and other substances through a vein in your arm (also known as infusion therapy). Henry Ford is the only program in Michigan with an infusion center dedicated to headache patients. Same-day care is typically available. Read more about outpatient headache infusion therapy.

Trigeminal autonomic cephalalgia evaluation

Before conducting a neurologic exam, we spend time with you to understand what you’re experiencing. We also listen to your concerns, making it easier to tailor therapies to your needs.

We may ask you:

  • What the headaches feel like and what other symptoms you’re experiencing
  • How quickly the pain accelerates, how long it lasts and how frequently it occurs
  • What activities you’re typically engaged in when attacks start
  • Your health history, including medications you take for other conditions
  • Headache medications you’re taking if any, and whether they bring relief

Imaging studies help us rule out other causes of sudden, severe headaches, like aneurysms or tumors. We may recommend magnetic resonance imaging (MRI) or a computed tomography (CT) scan.

Treating trigeminal autonomic cephalalgia with indomethacin

Indomethacin is a nonsteroidal anti-inflammatory drug that reduces inflammation and relieves pain in some forms of trigeminal autonomic cephalalgia. Treatment with indomethacin helps most patients feel better, but it often causes side effects. You may experience stomach issues, nausea and tiredness. High doses of indomethacin can cause complications, including ulcers and kidney problems. Your doctor will review your medical history and decide if this medication is right for you.

We start you on a small dose, and monitor your response, increasing it as necessary to help you get relief. If you need a higher dose of indomethacin, your care may include additional medications to lower the risk of complications. Once symptoms are under control, we may check to see if you can maintain the same results on a lower amount.

Other treatments for trigeminal autonomic cephalalgia

If you cannot tolerate the side effects of indomethacin, or it fails to relieve your symptoms, you still have options.

Additional treatments may include:

  • Alternative therapies: Relaxation techniques, acupuncture and massage are therapies that work with headache treatments to keep symptoms under control. Find out more about integrative medicine.
  • Injections and pain blocks: We help quiet the pain by injecting numbing medication or other substances into nerves in the affected area. These fast-acting medications may help you get relief during symptom flare-ups. Find out more about headache nerve blocks and injections.
  • Other medications: We may recommend anti-inflammatories that do not cause severe side effects. Drugs for other medical conditions, including depression may also decrease pain and may be easier to tolerate.
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