Introduction: The International Classification of Headache Disorders only recognizes the following as trigeminal- autonomic cephalalgias (TAC): cluster headache, paroxysmal hemicrania and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome. Nevertheless, there are other types of TAC that still have not been incorporated into the International Classification of Headache Disorders although they have been before reported in the literature. We present the results of the analysis of a series of 94 cases of TAC.
Methods: We performed a retrospective study of 2,132 patient who attended a general neurology consultation due to headache between January 1997 and June 2006. Those patients with unilateral headache (orbital, supraorbital y/o temporal) accompanied of some ipsilateral autonomic sign were selected. We investigated the etiology of all cases and made a nosology classification according with two types of criteria: IHS (International Headache Society) strict criteria as well as other criteria (IHS plus) including migraine with ipsilateral autonomic signs and hemicrania continua, thus following Goabsby.
Results: A total of 94 cases of TAC (4.4% of all the headaches) were found, 89 of which had a primary etiology and 5 secondary etiology. Cluster headache was the most frequent TAC in our series (29%), independently of the criteria used. However, hemimigraine with ipsilateral autonomic signs had a similar frequency (28%) according to IHS plus criteria.
Conclusions: a) In our series TAC have constituted an not very frequent entity, there being a subgroup of secondary cases among them, and b) the current International Classification of the Headache Disorders has some limitations as an instrument for the nosology classification of TAC.