Headache and Facial Pain Lasting Less Than Four Hours: Focus on Patients with Cranial Autonomic Features

Objective: The aim of our research was to evaluate the demographic and clinical features, treatment characteristics, and responses of the patients who presented to the Ege University Neurology Headache Outpatient Clinic with headaches lasting less than 4 hours. Another primary goal was to compare the characteristics mentioned above of patients with and without cranial autonomic symptoms.
Materials and Methods: Our study was retrospective and cross-sectional. The findings were based on the data collected at our tertiary headache center. Headache disorder diagnoses were made in accordance with the International Classification of Headache Disorders-3 guideline. We reviewed the patients’ charts and recorded the information on a standardized form. The patients’ clinical features, and treatment responses were noted. The patients were divided into two groups as those with and without autonomic findings, and the above-mentioned features were compared. Treatment responses of patients with trigeminal autonomic cephalgia (TAC) and patients with trigeminal neuralgia (TN) were analyzed via logistic regression analysis. Values of p<0.05 were considered statistically significant.
Results: Sixty-eight patients were included. Twenty-five patients had TAC. Twenty-three patients had TN and 13 had tension type headache. Seven had other primary headaches. The patients’ clinical features and treatment responses were different in the subgroups. In patients with TAC, having a triggering factor [Odds ratio (OR): 0.059, 95% confidence interval (CI): (0.005-0.645); p=0.02] reduced the risk of need of attack treatment. In patients with TN, having a brainstem lesion on cranial magnetic resonance imaging sequences [OR: 24.776, 95% CI: (1.033-60.613); p=0.049] increased the risk of long-term treatment failure with carbamazepine, whereas having headache attacks more than once a day [OR: 0.58, 95% CI: (0.04-0.832); p=0.036] decreased the risk.
Conclusion: The correct diagnosis of headache disorders is mainly based on the clinical features of the headache. For an effective treatment initiation, a correct diagnosis is mandatory, entirely dependent on adequate history taking.