What are Trigeminal Autonomic Cephalalgias (TACs)?

Trigeminal Autonomic Cephalalgias (TACs) are a group of rare but severe primary Headache disorders are characterised by intense one-sided head or facial pain, often around the eye or temple, accompanied by autonomic symptoms such as tearing, nasal congestion,
eyelid swelling, or pupil changes.

The most common types include:

  • Cluster Headache
  • Paroxysmal Hemicrania
  • SUNCT/SUNA (Short-lasting Unilateral Neuralgiform headache attacks with
    Conjunctival injection and Tearing / Autonomic symptoms)

These conditions are distinct from migraine or tension-type headaches and usually require
specialist diagnosis and targeted treatment.

What are the symptoms?

You may experience:

  • Severe, stabbing, or burning pain on one side of the head, face, or eye
  • Attacks that last from seconds to hours, depending on the subtype
  • Autonomic features on the affected side, such as:
    o Red, teary eye
    o Nasal congestion or runny nose
    o Eyelid swelling or drooping
    o Pupil constriction
  • Restlessness or agitation during attacks (especially in cluster headache)
  • Frequent, often predictable patterns of attacks, with periods of remission in some types

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 block may reduce pain and attack frequency in cluster headache and other TACs
  • In some cases, supraorbital or infraorbital nerve blocks are used to reduce localised pain input
  • These are safe, minimally invasive day procedures, especially helpful during active
    headache cycles

2. Stellate Ganglion Block

  • For upper face or eye-predominant pain with autonomic features, we may offer a stellate ganglion block to reduce sympathetic nervous system activity

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.
  • In line with local prescribing guidelines, we do not prescribe opioids or pregabalin. Your GP or neurologist should manage these.
  • We can offer recommendations to your GP as part of a broader care plan and support
    the use of evidence-based preventive and acute treatments (e.g. verapamil,
    indomethacin, melatonin — as advised by neurology).

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