What are Trigeminal Autonomic Cephalalgias (TACs)?

Trigeminal Autonomic Cephalalgias (TACs) are a group of rare but severe primary headache and facial pain disorders characterised by intense, one-sided head or facial pain, typically centred around the eye or temple. 

Facial pain is accompanied by autonomic symptoms such as tearing of the eye, redness of the eye, nasal congestion or a runny nose, eyelid swelling, drooping of the eyelid, or changes in pupil size.

The most common types include:

  • Cluster headache
  • Paroxysmal hemicrania
  • SUNCT/SUNA (Short-lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing / Short-lasting Unilateral Neuralgiform Headache Attacks with Cranial Autonomic Symptoms)

These conditions are distinct from trigeminal neuralgia, migraine, and tension-type headache and usually require specialist assessment, accurate diagnosis, and targeted treatment.

What are the symptoms?

You may experience:

  • Severe, stabbing, burning, or piercing pain on one side of the head, face, or around the eye
  • Attacks lasting from seconds to several hours, depending on the subtype
  • Autonomic symptoms on the affected side, such as:
    • Red, watery eye
    • Nasal congestion or a runny nose
    • Eyelid swelling or drooping
    • Constriction of the pupil
  • Restlessness or agitation during attacks (particularly in cluster headache)
  • Frequent attacks that often follow a predictable pattern, with periods of remission in some subtypes

How is it diagnosed?

Diagnosis is based on:

  • A detailed clinical history focused on headache pattern, duration, frequency, and associated symptoms

  • Exclusion of secondary causes via neuroimaging (usually MRI)

  • Review of your response to specific treatments, such as indomethacin for paroxysmal hemicrania

  • Clear classification is essential, as treatment differs between subtypes

What treatments do we offer?

We offer a multidisciplinary, non-surgical approach to help manage pain and reduce attack
frequency/severity:

1. Peripheral Nerve Blocks

  • Occipital Nerve Blocks: Occipital nerve blocks may help reduce pain intensity and attack frequency in selected patients with cluster headache and other trigeminal autonomic cephalalgias (TACs).
  • Supra-orbital and Infra-orbital Nerve Blocks: In selected cases, we may offer supra-orbital or infra-orbital nerve blocks to reduce localised pain input and help control symptoms.
  • These are safe, minimally invasive day-case procedures, which may be particularly helpful during active headache cycles.

2. Stellate Ganglion Block

  • For selected patients with upper facial or eye-predominant pain associated with autonomic features, we may offer a stellate ganglion block to help reduce sympathetic nervous system activity as part of a broader treatment strategy.

3. Pulsed Radiofrequency Treatment

  • If nerve blocks offer temporary relief, pulsed RF may be considered for longer-
    lasting modulation of affected nerves
  • This approach preserves nerve function while helping to interrupt pain transmission

4. Medication Optimisation

  • We offer a detailed review of your current headache medications to ensure they are
    safe and effective.
  • We can offer recommendations to your GP as part of a broader care plan and support
    the use of evidence-based preventive medications.

Supportive Care & Self-Management

  • Advice on headache diaries, trigger avoidance, and pacing
  • Guidance on sleep, stress, and lifestyle factors that may influence attack frequency
  • Referral to neurology or psychology may be considered in complex or treatment- resistant cases

What to expect from treatment

  • TACs are severe but manageable with the right diagnosis and targeted treatment
  • Our goal is to reduce attack frequency and severity, improve daily function, and minimise reliance on medications with side effects
  • Procedures are outpatient-based and delivered as day cases, with review as needed