Trigeminal Autonomic Cephalalgias

Questions and Answers

Q: Of the primary headache types are there some that are more difficult to treat than others?

A: Probably the Trigeminal Autonomic Cephalalgia (TACs).

The underlying disorder in the TACs is a sensitised brain stem.  The way to determine the relevancy of cervical afferents in headache, Migraine or TAC presentations is reproduction and resolution of head pain.

Reproduction alone of accustomed head pain is not enough. To assume this confirms relevancy can be misleading – reproduction and relevancy is the strongest clinical feature of cervical relevancy … i.e. Reproduction + Resolution = Relevancy™.  This occurs in the vast majority of TACs, and of these the C2-3 segment in Cluster Headache seems more reluctant to change its behaviour.

The approach is exactly the same, centralise C2 and then see where you go from there.

Q: And how many do you see?

A: Approximately 10% of patients present with a Cluster Headache presentation or ‘clustering’ headache and, or with, accompanying symptoms suggestive of a TAC.

Q: If you get a patient with a TAC what chance is there for a technique exacerbating the symptoms and what sort of warning should we give the patient?

A: This is tricky because head pain is coming and going frequently; head pain within an hour of treatment doesn’t necessarily mean that treatment has caused the exacerbation.

Increased severity, and, or increased frequency could suggest exacerbation.  Exacerbation results from disturbing C2-3 (more!).

The post treatment warning is no different to the usual.

Always, always check C2 before finishing the session

The likelihood of exacerbating the TACs is no more than in Migraine; Tension Headache is less likely.  Invariably, exacerbation of symptoms results from missing/misreading C2-3.  Managing C2-3 requires skill (there is no substitute for experience), patience and perseverance … always, always check C2 before finishing the session.

Until next time

If you are new to Watson Headache®, welcome to the Watson Headache® Approach, an evidence-informed practice when considering the role of the neck in Cervicogenic and Primary Headache.

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