Trigeminal Autonomic Cephalalgias
Do you suffer from one-sided headaches around your eyes? It could be a TAC.
Unlike common headaches or even migraines, Trigeminal Autonomic Cephalalgias (TACs) have a very distinct pattern—short but intense attacks that occur multiple times a day, often at the same time of day or night. Because these headaches mimic other conditions like sinus problems, migraines, or even dental pain, they are often misdiagnosed for years.
What are Trigeminal Autonomic Cephalalgias (TACs)?
TACs are rare primary headache disorders that combine severe one-sided head pain with autonomic features like eye watering, nasal congestion, or facial flushing.
How are TACs different from migraines?
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Migraines often last hours to days and may include nausea, light sensitivity, or aura. TACs, in contrast, usually cause shorter, more frequent, and sharper attacks with prominent eye and nasal symptoms.
What types of TACs exist?
The main conditions within this group are:
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Cluster Headache – often called “suicide headache” because of the unbearable intensity.
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Paroxysmal Hemicrania – frequent, shorter-lasting attacks that respond dramatically to specific medication.
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SUNCT/SUNA – very short stabbing headaches with tearing and eye redness.
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Hemicrania Continua – a continuous one-sided headache with flare-ups of severe pain.
Because TACs can be mistaken for migraine, sinus disease, or dental problems, patients often experience a delay in diagnosis. Recognizing TACs is important because they respond well to specific treatments, some of which are highly effective but condition-specific.
What causes TACs?
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The exact cause isn’t fully known. Research suggests involvement of the trigeminal nerve (pain pathway), hypothalamus (biological clock), and autonomic nervous system.
Who are at risk for developing TAC?
TACs are relatively rare, but certain people are more likely to develop them:
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Age & Gender: Cluster headache (the most common TAC) often affects men more than women and usually begins between ages 20 and 50. Other TACs, such as SUNCT/SUNA or paroxysmal hemicrania, can occur at any age.
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Family History: Some people may have a genetic predisposition, particularly for cluster headaches.
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Lifestyle Factors: Smoking and heavy alcohol use are known risk factors, especially for cluster headache attacks.
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Medical History: People who already experience primary headache disorders (like migraine) may be more likely to develop or be misdiagnosed when TACs begin.
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Triggers: While TACs often occur spontaneously, certain triggers—such as alcohol, changes in sleep, or seasonal shifts—can set off attacks in predisposed individuals.
Even though TACs are uncommon, they can affect otherwise healthy individuals with no clear warning. If you experience sudden, severe, one-sided headaches with eye redness, tearing, or nasal congestion, it’s important to seek evaluation by a headache or orofacial pain specialist.
How is TAC diagnosed?
Diagnosis is based on a detailed history and symptom pattern. We may need to order MRI scans to rule out secondary causes of the pain.
How are TACs treated?
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Cluster headache: oxygen therapy, triptans, preventive medications.
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Paroxysmal hemicrania & hemicrania continua: usually respond dramatically to indomethacin.
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SUNCT/SUNA: often treated with anti-seizure medications.
Can TAC be misdiagnosed?
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Yes, Trigeminal Autonomic Cephalalgias (TACs) can be misdiagnosed because their symptoms often overlap with other primary headache disorders like migraine, sinus headaches, or trigeminal neuralgia.
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Cluster headaches may be mistaken for sinus infections due to eye tearing and nasal congestion.
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Paroxysmal hemicrania can resemble migraine, but unlike migraine, it responds dramatically to indomethacin.
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SUNCT/SUNA may be confused with trigeminal neuralgia because of their short, stabbing facial pains.
👉 Early and accurate diagnosis is important because TACs often require very specific treatments that differ significantly from standard migraine or sinus headache management.
Can TACs be cured?
There is currently no cure, but with the right treatment, many patients experience significant relief and improved quality of life.
Takeaway:
Trigeminal Autonomic Cephalalgias (TACs) are not just “bad headaches”—they are a group of rare but highly distinctive conditions that cause severe, one-sided pain with eye and nasal symptoms. Because they are often misdiagnosed as migraines, sinus problems, or dental pain, it’s important to seek care from a specialist who understands these disorders.
With the right diagnosis, effective treatments are available—from targeted medications to nerve blocks and other advanced therapies. If you suffer from sudden, repeated headaches with eye or nasal symptoms, you don’t have to live in uncertainty. Relief begins with a proper diagnosis.
