Trigeminal Autonomic CephalalgiasTrigeminal Autonomic
CephalalgiasManjit S Matharu Manjit S MatharuHeadache Group,
Institute of Neurology & Headache Group, Institute of Neurology
&The National Hospital for Neurology and Neurosurgery The
National Hospital for Neurology and Neurosurgeryondonondon !"
!"Third #iennial Hull$#ASH Headache Meeting %&rd 'anuary
%(()Trigeminal Autonomic CephalgiasTrigeminal Autonomic
CephalgiasTrigeminal Autonomic CephalgiasTrigeminal Autonomic
Cephalgias*!nilateral head pain,!nilateral head pain, predominantly
+ predominantly +, ,*+ery se-ere . e/cruciating +ery se-ere .
e/cruciating*Cranial autonomic symptoms Cranial autonomic
symptoms01arasympathetic1arasympathetic 0SympatheticSympathetic
*Attac2 fre3uency and durationAttac2 fre3uency and duration differs
differs*Treatment responses differ Treatment responses
differ*!nilateral head pain,!nilateral head pain, predominantly +
predominantly +, ,*+ery se-ere . e/cruciating +ery se-ere .
e/cruciating*Cranial autonomic symptoms Cranial autonomic
symptoms01arasympathetic1arasympathetic 0SympatheticSympathetic
*Attac2 fre3uency and durationAttac2 fre3uency and duration differs
differs*Treatment responses differ Treatment responses
differ*Cluster Headache Cluster Headache*1aro/ysmal Hemicrania
1aro/ysmal Hemicrania*S!NCT 4Short$lastingS!NCT 4Short$lasting
!nilateral Neuralgiform!nilateral Neuralgiform headache 5ith
Conjuncti-alheadache 5ith Conjuncti-al injection and Tearing6
injection and Tearing6*Cluster Headache Cluster Headache*1aro/ysmal
Hemicrania 1aro/ysmal Hemicrania*S!NCT 4Short$lastingS!NCT
4Short$lasting !nilateral Neuralgiform!nilateral Neuralgiform
headache 5ith Conjuncti-alheadache 5ith Conjuncti-al injection and
Tearing6 injection and Tearing61aro/ysmal Hemicrania 1aro/ysmal
Hemicrania IHS CASSI7ICATI8N C9IT:9IA IHS CASSI7ICATI8N
C9IT:9IA1aro/ysmal Hemicrania 1aro/ysmal Hemicrania IHS
CASSI7ICATI8N C9IT:9IA IHS CASSI7ICATI8N C9IT:9IA *Se-ereSe-ere
*!nilateral!nilateral *8r;ital, supraor;ital or temporal8r;ital,
supraor;ital or temporal pain pain*%$&( minutes duration
%$&( minutes duration* of of the time the time*Associated
symptoms? Associated symptoms?$Conjuncti-al injection $Conjuncti-al
injection$acrimation $acrimation$1tosis $1tosis$Miosis
$Miosis$:yelid oedema $:yelid oedema$Nasal congestion $Nasal
congestion$9hinorrhea $9hinorrhea$7orehead and facial s5eating
$7orehead and facial s5eating*Stopped completely ;yStopped
completely ;y indomethacin indomethacinTrigeminal Autonomic
Cephalgias Trigeminal Autonomic CephalgiasTrigeminal Autonomic
Cephalgias Trigeminal Autonomic Cephalgias Cluster
Headache1aro/ysmal HemicraniaS!NCTAttac2fre3uency 4daily6 ,$@ ,$A(
&$%((Buration of attac2 ,=$,@(mins %$&(mins =$%A(secs1ain
3ualitySharp, thro;;ingSharp, thro;;ingSta;;ing, ;urningAutonomic
features CCC CCC CCCD9estlessor agitated )(> @(>
E=>Trigeminal Autonomic Cephalgias Trigeminal Autonomic
CephalgiasTrigeminal Autonomic Cephalgias Trigeminal Autonomic
Cephalgias ClusterCluster Headache Headache1aro/ysmal1aro/ysmal
Hemicrania HemicraniaS!NCT S!NCTMigrainous features CC CC CTriggers
Alcohol NTG CutaneousCCCCCC$CC$$$CCCCircadian periodicity F(>
A=> A;sent:pisodic ? Chronic )(?,( &=?E= ,(?)(Trigeminal
Autonomic Cephalgias Trigeminal Autonomic CephalgiasTrigeminal
Autonomic Cephalgias Trigeminal Autonomic Cephalgias Cluster
Headache1aro/ysmal HemicraniaS!NCTifetime pre-alence ,.,(((
,.=(,(((D ,.=(,(((D7?M ratio ,?%G=$FG% ,?, ,?,G=Age Mean
9ange&(E$EF&F=$E@A@,)$F=1aro/ysmal Hemicrania 1aro/ysmal
HemicraniaBI77:9:NTIA BIAGN8SIS BI77:9:NTIA BIAGN8SIS1aro/ysmal
Hemicrania 1aro/ysmal HemicraniaBI77:9:NTIA BIAGN8SIS BI77:9:NTIA
BIAGN8SIS*Symptomatic 1aro/ysmal HemicraniaSymptomatic 1aro/ysmal
Hemicrania*Cluster headacheCluster headache*S!NCT syndrome S!NCT
syndrome *Hemicrania continuaHemicrania continua*Symptomatic
1aro/ysmal HemicraniaSymptomatic 1aro/ysmal Hemicrania*Cluster
headacheCluster headache*S!NCT syndrome S!NCT syndrome *Hemicrania
continuaHemicrania continuaSymptomatic 1aro/ysmal Hemicrania
Symptomatic 1aro/ysmal HemicraniaSymptomatic 1aro/ysmal Hemicrania
Symptomatic 1aro/ysmal Hemicrania+ascular +ascularICA aneurysm ICA
aneurysmSu;cla-ian artery dilatation Su;cla-ian artery
dilatation1arietal A+M 1arietal A+MMCA Stro2e MCA Stro2e8ccipital
infarction 8ccipital infarctionInflammatory or Infection
Inflammatory or InfectionCollagen -ascular disease Collagen
-ascular disease8phthalmic herpes Hoster 8phthalmic herpes
HosterIatrogenic IatrogenicSurgical sympathectomy Surgical
sympathectomyTumours Tumours1ituitary tumours 1ituitary
tumours7rontal tumour 7rontal tumourTu;er cinereum hamartoma Tu;er
cinereum hamartomaSella turcica gangliocytoma Sella turcica
gangliocytomaCa-ernous sinus meningioma Ca-ernous sinus
meningiomaMultiple parotid caG Metastasis Multiple parotid caG
MetastasisNon$Hodg2inIs lymphoma Non$Hodg2inIs lymphoma1ancoast
syndrome 1ancoast syndromeMiscellaneous Miscellaneous:ssential
throm;ocythaemia :ssential throm;ocythaemiaIntracranial
hypertension Intracranial hypertensionMa/illary cyst Ma/illary
cystTrigeminal Autonomic Cephalgias1ituitary and TACsTrigeminal
Autonomic Cephalgias1ituitary and TACsCittadini and Matharu,
Neurologist %(()iterature re-ie5 of symptomatic TACs pu;lished
;et5een ,)F=$%((FIdentified &F symptomatic cases of CH=(>
had typical presentation&&> poor response to
treatmentsCittadini and Matharu, Neurologist %(()iterature re-ie5
of symptomatic TACs pu;lished ;et5een ,)F=$%((FIdentified &F
symptomatic cases of CH=(> had typical
presentation&&> poor response to treatmentsCause
CHNJ%A1HNJ&S!NCTNJ,(+ascular lesions @ Tumours1ituitary
tumour,% F &,(FMiscellaneousIdiopathic granulomatous
hypophysitisA , Trigeminal Autonomic Cephalgias 1ituitary and
TACsTrigeminal Autonomic Cephalgias 1ituitary and TACse-y et al,
#rain %((=*@A pituitary tumour patients 5ith headaches
studied*)> had TACs*7unctioning adenomas more li2ely to cause
TACs*In-estigate all TAC patients for pituitary tumoursK*1re-alence
of pituitary tumours in TACs is un2no5n*, in ,( of the population
ha-e an incidental pituitary micro$adenoma 4L ,cm diameter6 on
routine M9I *, in =(( ha-e a macro$adenoma e-y et al, #rain %((=*@A
pituitary tumour patients 5ith headaches studied*)> had
TACs*7unctioning adenomas more li2ely to cause TACs*In-estigate all
TAC patients for pituitary tumoursK*1re-alence of pituitary tumours
in TACs is un2no5n*, in ,( of the population ha-e an incidental
pituitary micro$adenoma 4L ,cm diameter6 on routine M9I *, in =((
ha-e a macro$adenoma Trigeminal Autonomic Cephalgias 1ituitary and
TACsTrigeminal Autonomic Cephalgias 1ituitary and TACs* Bifficult
to dra5 up definiti-e guidelines from retrospecti-e
re-ie5s*1ituitary imaging should ;e performed in?0 Atypical
phenotype.a;normal e/amination0 Treatment resistant cases* Bo
typical cases re3uire neuroimagingK 0 Increases li2elihood of
identifying incidental lesion*Implication of data on pituitary
lesionsK0 Need prospecti-e community ;ased study in CH patients0
Carefully elicit symptoms related to pituitary disease in all TAC
patients ;ut only perform M9I scans of the pituitary and a ;asal
pituitary hormone profile in? * patients 5ith atypical features
4including pituitary related symptoms6* a;normal e/amination * poor
response to appropriate treatmentsG* Bifficult to dra5 up
definiti-e guidelines from retrospecti-e re-ie5s*1ituitary imaging
should ;e performed in?0 Atypical phenotype.a;normal e/amination0
Treatment resistant cases*Bo typical cases re3uire neuroimagingK 0
Increases li2elihood of identifying incidental lesion*Implication
of data on pituitary lesionsK0 Need prospecti-e community ;ased
study in CH patients0 Carefully elicit symptoms related to
pituitary disease in all TAC patients ;ut only perform M9I scans of
the pituitary and a ;asal pituitary hormone profile in? * patients
5ith atypical features 4including pituitary related symptoms6*
a;normal e/amination * poor response to appropriate
treatmentsG1aro/ysmal Hemicrania 1aro/ysmal HemicraniaBI77:9:NTIA
BIAGN8SIS BI77:9:NTIA BIAGN8SIS1aro/ysmal Hemicrania 1aro/ysmal
HemicraniaBI77:9:NTIA BIAGN8SIS BI77:9:NTIA BIAGN8SIS*Symptomatic
1aro/ysmal HemicraniaSymptomatic 1aro/ysmal Hemicrania*Cluster
headacheCluster headache*S!NCT syndrome S!NCT syndrome *Hemicrania
continuaHemicrania continua*Symptomatic 1aro/ysmal
HemicraniaSymptomatic 1aro/ysmal Hemicrania*Cluster headacheCluster
headache*S!NCT syndrome S!NCT syndrome *Hemicrania
continuaHemicrania continuaCluster Headache +s 1aro/ysmal
Hemicrania Cluster Headache +s 1aro/ysmal HemicraniaCluster
Headache +s 1aro/ysmal Hemicrania Cluster Headache +s 1aro/ysmal
Hemicrania
Trial of Indomethacin if? Trial of Indomethacin if?,G ,G Attac2
fre3uencyAttac2 fre3uency < < = daily = daily%G %G Attac2
durationAttac2 duration L L &( minutes &( minutes&G
&G Chronicsu;types Chronicsu;typesFeature Feature CH CH PH
PHGender 4M?76 Gender 4M?76 %G=$F?, %G=$F?, ,?, ,?,Buration 4min6
Buration 4min6 ,= $ ,@( ,= $ ,@( % 0 &( % 0 &(7re3uency
4attac2s.day6 7re3uency 4attac2s.day6 ,$ @ ,$ @ , $ A( , $
A(Indomethacin Indomethacin $ $ C C1aro/ysmal Hemicrania 1aro/ysmal
HemicraniaBI77:9:NTIA BIAGN8SIS BI77:9:NTIA BIAGN8SIS1aro/ysmal
Hemicrania 1aro/ysmal HemicraniaBI77:9:NTIA BIAGN8SIS BI77:9:NTIA
BIAGN8SIS*Symptomatic 1aro/ysmal HemicraniaSymptomatic 1aro/ysmal
Hemicrania*Cluster headacheCluster headache*Hemicrania
continuaHemicrania continua*S!NCT syndromeS!NCT syndrome
*Symptomatic 1aro/ysmal HemicraniaSymptomatic 1aro/ysmal
Hemicrania*Cluster headacheCluster headache*Hemicrania
continuaHemicrania continua*S!NCT syndromeS!NCT syndrome Hemicrania
Continua Hemicrania ContinuaHemicrania Continua Hemicrania
Continua*!nilateral headache !nilateral headache*7orehead, temple,
or;it and occiput 7orehead, temple, or;it and occiput*Continuous,
moderate pain Continuous, moderate pain*:/acer;ations?
:/acer;ations?0lasting from %( min to se-eral dayslasting from %(
min to se-eral days 0accompanied ;y autonomicand migrainous
features accompanied ;y autonomicand migrainous features0occur in
F=> occur in F=>*ac2 of precipitating factors ac2 of
precipitating factors*Complete response to indomethacin Complete
response to indomethacin*!nilateral headache !nilateral
headache*7orehead, temple, or;it and occiput 7orehead, temple,
or;it and occiput*Continuous, moderate pain Continuous, moderate
pain*:/acer;ations? :/acer;ations?0lasting from %( min to se-eral
dayslasting from %( min to se-eral days 0accompanied ;y
autonomicand migrainous features accompanied ;y autonomicand
migrainous features0occur in F=> occur in F=>*ac2 of
precipitating factors ac2 of precipitating factors*Complete
response to indomethacin Complete response to
indomethacin1aro/ysmal Hemicrania1aro/ysmal Hemicrania T9:ATM:NTS
T9:ATM:NTS1aro/ysmal Hemicrania1aro/ysmal Hemicrania T9:ATM:NTS
T9:ATM:NTS N=77Indomethacin? Indomethacin?*8ral Indomethacin trial
8ral Indomethacin trial0%=mgs tds %=mgs tds0=(mgs tds =(mgs tds0If
high inde/ of suspicion? F=mgs tdsIf high inde/ of suspicion? F=mgs
tds 0o5er doses for & daysM ma/imum doseo5er doses for &
daysM ma/imum dose forfor F days F days*Indotest 4Intramuscular
indomethacin6 Indotest 4Intramuscular indomethacin6Indomethacin?
Indomethacin?*8ral Indomethacin trial 8ral Indomethacin trial0%=mgs
tds %=mgs tds0=(mgs tds =(mgs tds0If high inde/ of suspicion? F=mgs
tdsIf high inde/ of suspicion? F=mgs tds 0o5er doses for &
daysM ma/imum doseo5er doses for & daysM ma/imum dose forfor F
days F days*Indotest 4Intramuscular indomethacin6 Indotest
4Intramuscular indomethacin61aro/ysmal Hemicrania1aro/ysmal
Hemicrania INB8T:ST INB8T:ST1aro/ysmal Hemicrania1aro/ysmal
Hemicrania INB8T:ST INB8T:ST N=77 TimeIndomethacin =(mgs
intramuscularly@G%CAG% hrIndomethacin ,((mgs
intramuscularly,,G,C&G= hrTimeAdapted from Antonaci et alG
Headache ,))@M&@?,%%$@1aro/ysmal Hemicrania1aro/ysmal
Hemicrania T9:ATM:NTS T9:ATM:NTS1aro/ysmal Hemicrania1aro/ysmal
Hemicrania T9:ATM:NTS T9:ATM:NTS N=77*Indometacin
Indometacin1ersistence of efficacy 1ersistence of
efficacy%&> de-elop GI side effects 5ith chronic treatment
%&> de-elop GI side effects 5ith chronic treatment*8ther
NSAIBS 8ther NSAIBS??Aspirin, napro/en, piro/icam Aspirin,
napro/en, piro/icam*C8N$II Inhi;itors C8N$II Inhi;itors??Celeco/i;,
9ofeco/i; Celeco/i;, 9ofeco/i;*Topiramate Topiramate*+erapamil
+erapamil*Greater occipital ner-e injection Greater occipital ner-e
injection*Indometacin Indometacin1ersistence of efficacy
1ersistence of efficacy%&> de-elop GI side effects 5ith
chronic treatment %&> de-elop GI side effects 5ith chronic
treatment*8ther NSAIBS 8ther NSAIBS??Aspirin, napro/en, piro/icam
Aspirin, napro/en, piro/icam*C8N$II Inhi;itors C8N$II
Inhi;itors??Celeco/i;, 9ofeco/i; Celeco/i;, 9ofeco/i;*Topiramate
Topiramate*+erapamil +erapamil*Greater occipital ner-e injection
Greater occipital ner-e injectionS!NCTS!NCT S!NCTS!NCT
SShort$lasting hort$lasting UUnilateral nilateral NNeuralgiform
attac2s 5ith euralgiform attac2s 5ith CConjuncti-al injection and
onjuncti-al injection and TTearingearing S!NCTS!NCT IHS
CASSI7ICATI8N C9IT:9IA IHS CASSI7ICATI8N C9IT:9IAS!NCTS!NCT IHS
CASSI7ICATI8N C9IT:9IA IHS CASSI7ICATI8N C9IT:9IA*!nilateral
or;ital, supraor;ital or temporal pain !nilateral or;ital,
supraor;ital or temporal pain*Sta;;ing or pulsating pain Sta;;ing
or pulsating pain*,($%A( seconds duration ,($%A( seconds
duration*Attac2 fre3uency from &$%((.day Attac2 fre3uency from
&$%((.day*1ain is accompanied ;y conjuncti-al injection and
lacrimation 1ain is accompanied ;y conjuncti-al injection and
lacrimation*!nilateral or;ital, supraor;ital or temporal pain
!nilateral or;ital, supraor;ital or temporal pain*Sta;;ing or
pulsating pain Sta;;ing or pulsating pain*,($%A( seconds duration
,($%A( seconds duration*Attac2 fre3uency from &$%((.day Attac2
fre3uency from &$%((.day*1ain is accompanied ;y conjuncti-al
injection and lacrimation 1ain is accompanied ;y conjuncti-al
injection and lacrimationTrigeminal Autonomic Cephalgias Trigeminal
Autonomic CephalgiasTrigeminal Autonomic Cephalgias Trigeminal
Autonomic Cephalgias Cluster Headache1aro/ysmal
HemicraniaS!NCTAttac2fre3uency 4daily6 ,$@ ,$A( &$%((Buration
of attac2 ,=$,@(mins %$&(mins =$%A(secs1ain 3ualitySharp,
thro;;ingSharp, thro;;ingSta;;ing, ;urningAutonomic features CCC
CCC CCCD9estlessor agitated )(> @(> E=>Trigeminal
Autonomic Cephalgias Trigeminal Autonomic CephalgiasTrigeminal
Autonomic Cephalgias Trigeminal Autonomic Cephalgias ClusterCluster
Headache Headache1aro/ysmal1aro/ysmal Hemicrania HemicraniaS!NCT
S!NCTMigrainous features CC CC CTriggers Alcohol NTG
CutaneousCCCCCC$CC$$$CCCCircadian periodicity F(> A=>
A;sent:pisodic ? Chronic )(?,( &=?E= ,(?)(Trigeminal Autonomic
Cephalgias Trigeminal Autonomic CephalgiasTrigeminal Autonomic
Cephalgias Trigeminal Autonomic Cephalgias Cluster
Headache1aro/ysmal HemicraniaS!NCTifetime pre-alence ,.,(((
,.=(,(((D ,.=(,(((D7?M ratio ,?%G=$FG% ,?, ,?,G=Age Mean
9ange&(E$EF&F=$E@A@,)$F=S!NCTS!NCT BI77:9:NTIA BIAGN8SIS
BI77:9:NTIA BIAGN8SISS!NCTS!NCT BI77:9:NTIA BIAGN8SIS BI77:9:NTIA
BIAGN8SIS *Secondary causes Secondary causes01osterior fossa
pathology 1osterior fossa pathology01ituitary tumours 1ituitary
tumours*Trigeminal neuralgia Trigeminal neuralgia*1rimary sta;;ing
headache 1rimary sta;;ing headache*1aro/ysmal hemicrania 1aro/ysmal
hemicraniaS!NCT +s Trigeminal Neuralgia S!NCT +s Trigeminal
NeuralgiaS!NCT +s Trigeminal Neuralgia S!NCT +s Trigeminal
Neuralgia 7eature 7eature S!NCT S!NCT TN TNGender 4M?76 Gender
4M?76 ,G=?, ,G=?, ,?% ,?%Site of pain Site of pain + +, ,+ +%.&
%.&Buration 4secs6 Buration 4secs6 =$%A( =$%A( L= L=Autonomic
features Autonomic features 1rominent 1rominent Sparse
Sparse9efractory period 9efractory period A;sent A;sent 1resent
1resentTrigeminal +ascular loop Trigeminal +ascular loop F>
F> AF$)(> AF$)(>S!NCTS!NCT BI77:9:NTIA BIAGN8SIS
BI77:9:NTIA BIAGN8SISS!NCTS!NCT BI77:9:NTIA BIAGN8SIS BI77:9:NTIA
BIAGN8SIS *Sta;;ing or ja;;ing pain Sta;;ing or ja;;ing
pain*8phthalmic trigeminal8phthalmic trigeminal distri;ution
distri;ution*ast a fe5 seconds 4rarelyast a fe5 seconds 4rarely up
to , minute6 up to , minute6*8ccurs at irregular8ccurs at irregular
inter-als inter-als*Site of pain -aries fromSite of pain -aries
from attac2 to attac2 attac2 to attac2*Spontaneous attac2s only
Spontaneous attac2s only*Autonomic featuresAutonomic features
a;sent a;sent*Attac2s su;side 5ithAttac2s su;side 5ith indomethacin
indomethacin1rimary Sta;;ing Headache 1rimary Sta;;ing
HeadacheS!NCTS!NCT IN+:STIGATI8NS IN+:STIGATI8NSS!NCTS!NCT
IN+:STIGATI8NS IN+:STIGATI8NS M9I 4including pituitary -ie5s6M9I
4including pituitary -ie5s61ituitary hormone profile1ituitary
hormone profileTrial of indomethacinTrial of indomethacinS!NCTS!NCT
T9:ATM:NTS T9:ATM:NTSS!NCTS!NCT T9:ATM:NTS T9:ATM:NTS Boses Boses
Num;er Num;er :fficacy :fficacyamotrigine amotrigine ,(($A((mg.d
,(($A((mg.d %= %= E@> E@>Topiramate Topiramate =($A((mg.d
=($A((mg.d %, %, =%> =%>Ga;apentin Ga;apentin
E(($&E((mg.d E(($&E((mg.d %% %% A=> A=>I+ lidocaine
I+ lidocaine ,G&$&G& mg.2g.hr ,G&$&G&
mg.2g.hr ,, ,, ,((> ,((>Greater occipitalGreater occipital
ner-e injection ner-e injection@ @ E&> E&>Cohen et
alG Migraine Trust Symposium, Septem;er %((ES!NCTS!NCT T9:ATM:NTS
T9:ATM:NTSS!NCTS!NCT T9:ATM:NTS T9:ATM:NTS Cohen, Matharu, Goads;yG
IHS, %((FTopiramate in S!NCTCross$o-er9CT of topiramate =( ;d -s
place;o1rimary endpoint 5as reduction in attac2 fre3uency ;y =(>
Secondary endpoint 5as reduction in Oattac2 loadI
NJ=9esults#eneficial in % 0 one had complete cessation of attac2s,
and one had a F,> reduction in attac2 loadG 1lace;o response in
oneT5o had no ;enefitS!NCTS!NCT T9:ATM:NTS T9:ATM:NTSS!NCTS!NCT
T9:ATM:NTS T9:ATM:NTSHypothalamic Stimulator Hypothalamic
Stimulatoreone M,eone M, Ann Neurol Ann Neurol %((=G
%((=GTrigeminal Autonomic CephalgiasTrigeminal Autonomic Cephalgias
1ATH81HPSI88GP 1ATH81HPSI88GPTrigeminal Autonomic
CephalgiasTrigeminal Autonomic Cephalgias 1ATH81HPSI88GP
1ATH81HPSI88GPCluster HeadachePET StudyMay et al, Lancet
1998Ipsilateral hypothalamic acti-ation in CHTrigeminal Autonomic
CephalgiasTrigeminal Autonomic Cephalgias 1ATH81HPSI88GP
1ATH81HPSI88GPTrigeminal Autonomic CephalgiasTrigeminal Autonomic
Cephalgias 1ATH81HPSI88GP 1ATH81HPSI88GPParoxysmal HemicraniaPET
StudyMatharu et al, Ann Neurol 2006Contralateral hypothalamic
acti-ation in 1HTrigeminal Autonomic CephalgiasTrigeminal Autonomic
Cephalgias 1ATH81HPSI88GP 1ATH81HPSI88GPTrigeminal Autonomic
CephalgiasTrigeminal Autonomic Cephalgias 1ATH81HPSI88GP
1ATH81HPSI88GPSUNCTfMRI StudiesMay et al, Ann Neurol 1999 Cohen et
al, Cephalalgia 2004 Sprenger et al, Pain 200Hypothalamic
acti-ation in S!NCT7unctional Neuroimaging of 1rimary
HeadachesHeadache 1hase7unctional Neuroimaging of 1rimary
HeadachesHeadache 1hase:pisodic and Chronic Migraine :pisodic and
Chronic Migraine:pisodic and Chronic Migraine :pisodic and Chronic
MigraineSpontaneou! "pi!o#ic Migraine$eiller et al, Nature
199Spontaneou! "pi!o#ic MigraineA%ri#i et al, Arch Neurol
200Chronic Migraine Matharu et al, &rain 2004Specific dorsal
rostral pontine acti-ation in migraineTrigeminal Autonomic
CephalgiasTrigeminal Autonomic Cephalgias 1ATH81HPSI88GP
1ATH81HPSI88GPTrigeminal Autonomic CephalgiasTrigeminal Autonomic
Cephalgias 1ATH81HPSI88GP 1ATH81HPSI88GPHemicrania Continua
Hemicrania ContinuaHemicrania Continua Hemicrania ContinuaPET
StudyMatharu et al, 'ea#ache 2004Po!terior 'ypothala(u! )or!al
*o!tral Pon!*1rimary headaches can ;e pathophysiologically
differentiated on the ;asis of1rimary headaches can ;e
pathophysiologically differentiated on the ;asis of distinct
patterns of ;rain acti-ation distinct patterns of ;rain acti-ation
*Borsal pontine and hypothalamic acti-ation are mar2ers of
migrainousBorsal pontine and hypothalamic acti-ation are mar2ers of
migrainous symptoms and cranial autonomic features, respecti-ely
symptoms and cranial autonomic features, respecti-ely**These
structures that li2ely play a pi-otal role in the pathophysiology
ofThese structures that li2ely play a pi-otal role in the
pathophysiology of primary headache syndromes primary headache
syndromes *1rimary headaches can ;e pathophysiologically
differentiated on the ;asis of1rimary headaches can ;e
pathophysiologically differentiated on the ;asis of distinct
patterns of ;rain acti-ation distinct patterns of ;rain acti-ation
*Borsal pontine and hypothalamic acti-ation are mar2ers of
migrainousBorsal pontine and hypothalamic acti-ation are mar2ers of
migrainous symptoms and cranial autonomic features, respecti-ely
symptoms and cranial autonomic features, respecti-ely**These
structures that li2ely play a pi-otal role in the pathophysiology
ofThese structures that li2ely play a pi-otal role in the
pathophysiology of primary headache syndromes primary headache
syndromes Acti-ation pattern in primary headaches Acti-ation
pattern in primary headachesActi-ation pattern in primary headaches
Acti-ation pattern in primary headaches7unctional Neuroimaging of
1rimary Headaches 7unctional Neuroimaging of 1rimary
Headaches7unctional Neuroimaging of 1rimary Headaches 7unctional
Neuroimaging of 1rimary HeadachesMigraine Migraine CH CH S!NCT
S!NCT 1H 1H HC HC1osterior hypothalamus Borsal rostral pons Pain is
a more Pain is a more terrile lord of terrile lord of man!ind
thanman!ind than e"en death itself#e"en death itself#$lert
Sch%eit&er$lert Sch%eit&er
