top of page

Trigeminal Autonomic Cephalagia 

Trigeminal autonomic cephalalgias are primary headache disorders that are accompanied by autonomic symptoms (eye tearing, eye redness, nasal congestion, ear fullness). There are 5 main types of trigeminal autonomic cephalalgias with cluster headache being the most common and well known. 



Short-lasting unilateral neuralgiform headaches with conjunctival tearing (SUNCT) and short-lasting unilateral neuralgiform headaches with autonomic symptoms are similar and often grouped together. Both are characterized by moderate to severely painful headaches that occur on one side lasting seconds to minutes. They usually occur as either a single stab or a series of stabbing pains and are accompanied by symptoms that occur on the same side as the pain. SUNCT is accompanied by eye redness and tearing on the same side as the pain. SUNA may be accompanied by eye tearing or redness or other symptoms such as nasal congestion, facial flushing, eyelid drooping all of which are on the same side as the pain.


Paroxysmal hemicrania is characterized by multiple severely painful episodes throughout the day occurring on one side of the head usually lasting 2-30 minutes. These attacks usually are accompanied with a runny nose, nasal congestion, forehead sweating, eye tearing, eye redness or eyelid drooping on the side of the pain. 


Cluster headaches are a debilitating form of headache disorder characterized by excruciating, piercing pain localized unilaterally, often around the temple or behind the eye. These headaches are aptly named due to their tendency to occur in clusters, with multiple attacks happening over days, weeks, or even months, followed by periods of remission. Dr. Levi specializes in recognizing and effectively managing cluster headaches to alleviate suffering and improve quality of life.


The hallmark symptom of cluster headaches is intense, stabbing pain that can be described as a "hot poker" or a "drilling" sensation. This pain typically peaks in intensity within minutes and can last anywhere from 30 minutes to three hours. Individuals experiencing cluster headaches often report agitation, restlessness, and a sense of impending doom during an attack.

Associated Symptoms:

Cluster headaches are often accompanied by various autonomic symptoms on the affected side of the head, such as:

  • Runny Nose (Rhinorrhea): Excessive nasal discharge is a common feature during cluster headache attacks, often leading to congestion and discomfort.

  • Tearing (Lacrimation): Uncontrollable tearing of the eye on the affected side can occur concurrently with the headache.

Diagnosis and Treatment:

Diagnosing cluster headaches requires a thorough evaluation by a healthcare professional experienced in headache disorders. Our practice offers comprehensive assessments to accurately diagnose cluster headaches and differentiate them from other headache disorders or orofacial pain conditions.

Treatment strategies for cluster headaches may include:

  • Acute Management: Utilizing abortive medications to alleviate pain and reduce the duration of cluster headache attacks.

  • Preventive Therapies: Implementing long-term preventive measures to reduce the frequency and severity of cluster headache episodes.

  • Lifestyle Modifications: Identifying and addressing triggers that may precipitate cluster headaches, such as certain foods, stressors, or sleep disturbances.

Comprehensive Care:

At our practice, we understand the profound impact that cluster headaches can have on daily functioning and overall well-being. We are dedicated to providing compassionate care and personalized treatment plans tailored to each patient's unique needs. Through a multidisciplinary approach, we strive to empower individuals to effectively manage their cluster headaches and reclaim control over their lives.


Characterized by a continuous, one-sided headache persisting for over three months, this condition is often accompanied by autonomic symptoms, including eye tearing, eye redness, and nasal congestion. Additionally, patients may experience restlessness or agitation, akin to symptoms observed in cluster headaches.

Diagnostic Complexity and Similarities:

Diagnosing hemicrania continua requires a nuanced understanding of its clinical presentation, as it shares several features with other primary headache disorders, notably chronic migraine and cluster headache. The overlap in symptoms often complicates the diagnostic process, necessitating thorough evaluation and differential diagnosis.

Distinguishing Features:

Hemicrania continua bears similarities to chronic migraine making diagnosis challenging. Like chronic migraine, hemicrania continua manifests as a continuous headache, with fluctuations in intensity. Hemicrania continua is usually sidelocked meaning that it occurs on one side of the head and is often accompanied by autonomic symptoms. Response to indomethacin is considered diagnostic of hemicrania continua but there are individuals who do not respond to this medication or cannot tolerate it.

Treatment Approaches:

Managing hemicrania continua requires a multifaceted treatment approach tailored to the individual needs of each patient. The primary pharmacological intervention involves the use of indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), which has demonstrated efficacy in alleviating symptoms in the majority of cases. However, some patients may exhibit intolerance or contraindications to indomethacin, necessitating alternative treatment strategies.

In cases where indomethacin is ineffective or poorly tolerated, various treatments are available including medications, such as topiramate, celecoxib, or gabapentin, and neuromodulation.

Comprehensive Care:

Our multidisciplinary approach emphasizes not only symptom management but also patient education, support, and empowerment. By collaborating with a multidisciplinary team of specialists, we strive to provide comprehensive care tailored to address the unique needs of each individual.

If you suffer from headaches, we can help 

Headache treatments may include medication, behavioral modifications, botox, muscle injections, exercises, and dietary changes. Dr. Levi has extensive training and experience treating headache. 

Paroxysma Hemicrania
Cluster Headache
Hemicrania Continua
bottom of page