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Our Cluster Headache & TACs Program
Our Cluster Headache & TACs Program
We offer a dedicated Cluster Headache & Trigeminal Autonomic Cephalalgias (TACs) Program for patients with severe, one-sided headache disorders.
Trigeminal autonomic cephalalgias (TACs) are a group of rare but highly distinctive primary headache disorders. They are characterized by:
Severe, one-sided head pain (i.e., "side-locked headache)
Prominent eye and nasal symptoms on the same side
Activation of the trigeminal nerve and the autonomic nervous system
TACs are frequently misdiagnosed as migraine, leading to delays in effective treatment. Accurate recognition is essential because management differs substantially from migraine care.
The most common TAC is cluster headache - a severe primary headache disorder that is often mistaken for migraine. Accurate diagnosis is critical, because treatments for cluster headache are different — and highly effective when used correctly..
What this program offers
What this program offers
Specialist evaluation of severe unilateral headache disorders
Differentiation of TACs from migraine and secondary causes
Evidence-based acute treatment strategies
Diagnostic trials (e.g., indomethacin trial) when appropriate
Preventive treatment planning and monitoring
Who this program is for
Who this program is for
You may benefit from a TACs evaluation if you:
Have severe, one-sided headache attacks
Experience eye or nasal symptoms with headache
Feel restless or agitated during attacks
Have headaches that do not respond to typical migraine treatments
Have been told your headaches are “migraine” but the pattern does not fit
What defines a TAC?
What defines a TAC?
TACs share several defining features:
Unilateral (one-sided), side-locked pain
Cranial autonomic symptoms, such as:
Red or tearing eye
Nasal congestion or runny nose
Eyelid droop or pupil changes
Facial sweating or flushing
Distinctive behavior during attacks (often restlessness rather than lying still)
What are the main types of TACs?
What are the main types of TACs?
Cluster headache
Cluster headache
Most common TAC
Attacks last 15–180 minutes
Occur up to multiple times per day
Marked restlessness during attacks
Treated acutely with oxygen and injectable triptans
Prevented with medications such as verapamil
Paroxysmal hemicrania
Paroxysmal hemicrania
Shorter attacks (2-30 minutes)
Occur many times per day
Prominent autonomic symptoms
May be associated with restlessness/agitation
Complete response to indomethacin
Hemicrania continua
Hemicrania continua
Continuous, one-sided headache with superimposed flares
Autonomic symptoms may be present
May be associated with restlessness/agitation
Complete response to indomethacin
SUNCT / SUNA
SUNCT / SUNA
Very short attacks (seconds to minutes)
Neuralgiform pain with prominent autonomic features
Can occur dozens of times per day
What are clues I may have a TAC rather than migraine?
What are clues I may have a TAC rather than migraine?
You may have TAC rather than migraine if your attacks:
Are side-locked: always occurring exclusively in the same side of the head
Are very severe and short-lasting
Occur multiple times per day
Cause eye redness, tearing, or nasal symptoms
Make you feel restless or unable to lie down
How are TACs diagnosed?
How are TACs diagnosed?
The diagnosis is primarily made on clinical history (i.e., there is no investigation that proves someone has or does not have a TAC)
The diagnosis is based primarily on:
An expertly taken history
Presence of autonomic symptoms
Presence of agitation/restlessness
Exclusion of secondary headache disorders
Response to condition-specific treatments (i.e., indomethacin)
Imaging may be selectively used to exclude secondary causes when appropriate.
In selected cases, a structured indomethacin trial is used as a diagnostic tool.
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