Trigeminal autonomic cephalalgias: current insights into pathophysiology, diagnosis, and therapeutic strategies

BackgroundTrigeminal autonomic cephalalgias (TAC) are primary headache disorders characterized by unilateral craniofacial pain, usually periorbital or temporal, accompanied by ipsilateral autonomic symptoms such as tearing, nasal congestion, conjunctival injection, miosis, and ptosis. They include cluster headache, paroxysmal hemicrania, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks (SUNCT and SUNA). Diagnosis depends on attack duration, frequency, and intensity, though clinical overlap may occur. Accurate identification is crucial, as treatment differs among subtypes. Understanding TAC pathophysiology, particularly trigeminal autonomic activation, is essential for improving diagnosis, distinguishing them from similar disorders like migraine, and optimizing therapeutic management.ResultsTrigeminal autonomic cephalalgias represent a group of rare but disabling primary headache disorders characterized by overlapping pathophysiological pathways involving the hypothalamus and trigemino-autonomic reflex. Advances in neuroimaging and neuromodulation have refined understanding of their mechanisms and expanded therapeutic options beyond traditional pharmacotherapy. Early recognition and tailored, mechanism-based interventions remain essential to improving outcomes.ConclusionsWe believe it is very important and necessary to offer a comprehensive and up-to-date review of trigeminal autonomic headaches, emphasizing their common and distinctive clinical features, the underlying neurobiological mechanisms, and current evidence-based approaches for timely diagnosis and treatment.