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Pain part 9: trigeminal autonomic cephalalgias Norazah Abu Bakar Manjit Matharu Tara Renton Dental Update 2024 43:4, 707-709.
Authors
NorazahAbu Bakar
BDS, MFDS RCSEd, MSurgDent RCSEd, PhD, FDS RCSEd
Dental Institute, King's College London, Denmark Hill, London SE5 9RS and Headache Group, Institute of Neurology, The National Hospital for Neurology and Neurosurgery
Senior Lecturer and Honorary Consultant Neurologist, Headache Group, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG
Professor of Oral Surgery, King's College London; Honorary Consultant in Oral Surgery, King's College Hospital NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust, London
The trigeminal autonomic cephalalgias are a group of rare, highly disabling, primary headache syndromes distinctly characterized by the unilaterality of their attacks and presence of cranial autonomic symptoms. Although pain is often localized to the peri-orbital and temporal regions, it is not uncommon for pain to radiate to tooth-bearing areas and mimic toothache or jaw pain. Hence, dental practitioners should be aware of these syndromes to enable appropriate referral and avoid unnecessary, and often irreversible, dental treatments. Many dentists will not have heard of these conditions but must remain vigilant, and ensure that they are not confused with trigeminal neuralgia, so that their patients are appropriately advised and referred.
CPD/Clinical Relevance: The dental practitioners may be the first line of healthcare providers consulted by these patients in the hope of obtaining pain relief. Lack of familiarity with an uncommon condition may lead to poor patient management.
Article
The trigeminal autonomic cephalalgias (TACs) are a group of rare, short-lasting primary headache disorders that are characterized by strictly unilateral attacks of pain occurring in association with cranial autonomic symptoms. This group comprises cluster headache, paroxysmal hemicrania and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). Although these disorders are rare, patients may nonetheless present to their dental practitioners seeking possible treatment, especially since the pain may mimic dental pain or other orofacial pain conditions. It is therefore important that dental professionals are aware of these syndromes to enable better patient management and avoid unnecessary dental treatments.
The revised International Classification of Headache Disorders (ICHD-II) describes cluster headache (CH) as a rare primary headache characterized by attacks of severe, strictly unilateral pain which is orbital, supra-orbital or temporal (Table 1).1
Each cluster headache attack is excruciating, typically described by patients as the worst pain they have ever felt (even worse than trigeminal neuralgia!), resulting in patients being unable to cope with the recurrent attacks. Female patients invariably report that each attack is worse than childbirth. Patients are known to develop suicidal ideations, hence it is sometimes known as ‘suicide headaches’. Pain is often described as thermal or punctate in character, like ‘a hot red poker in the eye’.2 Alcohol, nitroglycerin, heat and the smell of volatile substances such as perfumes, solvents and varnish are known to be potent triggers for the headaches during a cluster period.2,3
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