Ens Teaching Review

Though migraine and tension-type headache are common, some primary headache syndromes are relatively rare and poorly recognized in daily practice. Despite the diagnostic challenges, the short-lasting primary headaches are important to recognize because of their excellent but highly selective response to treatment. In 1997 Goadsby and Lipton documented a nosological analysis and definition of a group of short-lasting headache syndromes [27]. These paroxysmal hemicranias are characterized by frequent short-lasting attacks of unilateral pain usually in the orbital, supraorbital or temporal region. The pain is severe and associated with autonomic symptoms such as conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, ptosis or eyelid oedema. They divided these short-lasting primary headache syndromes into those exhibiting marked autonomic activation and those without autonomic activation. Table 1 summarizes a list of short-living headaches with autonomic symptoms. The former group comprise chronic and episodic paroxysmal hemicrania, short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome) and cluster headache. These headache syndromes are compared with other short-lasting headache disorders, such as hypnic headache, and a chronic headache syndrome with milder autonomic features such as hemicrania continua [24, 25, 27]. Idiopathic stabbing headache, cough headache, exertional headache, sexual headache and trigeminal neuralgia are not part of these syndromes as these short-lasting disorders have no autonomic component [50]. JO N 1241 Received: 28 July 2003 Accepted: 30 July 2003