Trigeminal autonomic cephalalgia with strictly unilateral severe orbital pain in attack clusters, accompanied by cranial autonomic features.
Clinical features
- • 15–180 min attacks, 1–8 per day
- • Restlessness/agitation (unlike migraine)
- • Ipsilateral lacrimation, rhinorrhoea, ptosis, miosis
Management
- • Acute: high-flow 100% O₂ 12–15 L/min via non-rebreathe for 15 min
- • Sumatriptan 6 mg SC
- • Transitional: prednisolone 60 mg × 5 days with taper, or greater occipital nerve block
- • Prophylaxis: verapamil 240–960 mg/day with serial ECGs
Clinical pearls
- • Oral triptans are too slow — use SC or intranasal
- • Verapamil requires ECG before each dose escalation (heart block)
Related in WardRound
Educational — verify locally.
