Diğer Trigeminal Otonomik Sefaljiler
Özet
Trigeminal otonomik sefaljiler (TOS), paroksizmal hemikranya, hemikranya kontinua (HK), SUNCT ve SUNA sendromları ile küme baş ağrısını içeren primer baş ağrısı bozukluklarıdır. Benzer ağrı özellikleri gösterseler de atak sıklıkları ve süreleri açısından farklılaşırlar. Paroksizmal hemikranya, hayatın 3. dekadında başlar, kadınlarda daha sık görülür ve günlük, tek taraflı, kısa süreli keskin ağrılarla karakterizedir. Tanısı için indometazin tedavisine tam yanıt alınması şarttır. SUNCT ve SUNA sendromları genellikle 40-70 yaş arasında başlar ve erkeklerde biraz daha yaygındır. Kısa süreli, tek taraflı nevraljiform ağrılara konjunktival kanlanma, yaşarma, burun tıkanıklığı gibi otonomik semptomlar eşlik eder; SUNCT'ta hem kızarma hem yaşarma varken, SUNA'da bunlardan biri veya hiçbiri bulunur. Tedavide lamotrijin sıklıkla etkilidir. Hemikranya kontinua (HK) ise tek taraflı, orta şiddette sürekli bir baş ağrısı olup alevlenmelerle seyreder ve paroksizmal hemikranya gibi indometazin profilaksisine mükemmel yanıt verir. Bu sendromlar primer sınıflandırılsa da sekonder nedenlerle de ortaya çıkabileceğinden hastaların kraniyal MR ve baş/boyun arter görüntülemeleri ile değerlendirilmesi kritik önem taşır.
Trigeminal autonomic cephalalgias (TACs) are primary headache disorders that encompass paroxysmal hemicrania, hemicrania continua (HC), SUNCT, and SUNA syndromes, along with cluster headache. Although they present with similar pain characteristics, they differ in terms of attack frequency and duration. Paroxysmal hemicrania typically begins in the third decade of life, is more prevalent in women, and is characterized by daily, unilateral, short-lasting sharp pain, requiring a complete therapeutic response to indomethacin for diagnosis. SUNCT and SUNA syndromes generally onset between the ages of 40 and 70 and are slightly more common in men, presenting with brief, unilateral neuralgiform headaches accompanied by cranial autonomic symptoms such as conjunctival injection, tearing, or nasal congestion; SUNCT involves both injection and tearing, whereas SUNA features only one or neither. Lamotrigine is frequently effective in their treatment. Hemicrania continua (HC) is characterized by a continuous, unilateral, moderate-intensity headache with exacerbations, which, similar to paroxysmal hemicrania, highly responds to indomethacin prophylaxis. Even though these syndromes are classified as primary headaches, they can also occur secondarily, making cranial MRI and head/neck arterial imaging critically important for accurate differential diagnosis and successful management.
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