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JADA Continuing Education

A review and implications for dentistry

Background. The authors review the epidemiology, clinical features, pathophysiology, diagnosis, treatment, orofacial presentations and dental implications of trigeminal autonomic cephalalgias (TACs): cluster headache (CH), paroxysmal hemicrania (PH) and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT).

Types of Studies Reviewed. The authors conducted PUBMED searches for the period from 1968 through 2007 using the terms "trigeminal autonomic cephalalgias," "cluster headache," "paroxysmal hemicrania," "short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing," "epidemiology," "pathophysiology," "treatment," "oral," "facial" and "dentistry." They gave preference to articles reporting randomized, controlled trials and those published in English-language peer-reviewed journals.

Results. TACs refers to a group of headaches characterized by unilateral head pain, facial pain or both with accompanying autonomic features. Although their pathophysiologies are unclear, CH, PH and SUNCT may be differentiated according to their clinical characteristics. Current treatments for each of the TACs are useful in alleviating the pain, with few refractory cases requiring surgical intervention. Patients with TACs often visit dental offices seeking relief for their pain.

Clinical Implications. Although the prevalence of TACs is small, it is important for dentists to recognize the disorder and refer patients to a neurologist. This will avoid the pitfall of administering unnecessary and inappropriate traditional dental treatments in an attempt to alleviate the neurovascular pain.

Key Words: Trigeminal autonomic cephalalgias; cluster headache; paroxysmal hemicrania; short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing

Abbreviations: CH: Cluster headache. • ICHD-II: International Classification of Headache Disorders II. • NSAID: Nonsteroidal anti-inflammatory drug. • PH: Paroxysmal hemicrania. • SUNA: Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms. • SUNCT: Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. • TACs: Trigeminal autonomic cephalalgias. • TMDs: Temporomandibular disorders. • V2/V3 > V1: Maxillary/mandibular division greater than ophthalmic division of the trigeminal nerve.