Autonomic cardiovascular manifestations of trigeminal autonomic cephalalgias

Trigeminal autonomic cephalalgias (TACs) are rare headache syndromes characterized by headache accompanied by stereotypical ipsilateral facial autonomic features. Whether more general disruptions of autonomic dysfunction occur along the spectrum of TACs has not been well studied. This review examines the existing evidence concerning cardiovascular autonomic manifestations in TACs. We first review studies reporting cardiovascular findings in these syndromes. We then discuss the possible pathophysiological mechanisms of these findings at both central and peripheral levels of the nervous system. We conclude by discussing treatment modalities that may influence cardiovascular autonomic manifestations. The accumulated evidence suggests that cardiovascular autonomic manifestations of TACs may be more common than is generally recognized and are relevant to understanding the disease pathogenesis, diagnosis, and management.