Annals of Indian Academy of Neurology
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Year : 2018  |  Volume : 21  |  Issue : 5  |  Page : 1-2

Worst headaches of the humankind

Department of Neurology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India

Date of Web Publication11-Apr-2018

Correspondence Address:
Dr. Debashish Chowdhury
Room No 504, Department of Neurology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi - 110 002
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.AIAN_20_18

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How to cite this article:
Chowdhury D. Worst headaches of the humankind. Ann Indian Acad Neurol 2018;21, Suppl S1:1-2

How to cite this URL:
Chowdhury D. Worst headaches of the humankind. Ann Indian Acad Neurol [serial online] 2018 [cited 2023 Feb 3];21, Suppl S1:1-2. Available from:

Headache patients are commonly encountered by neurologists in their routine clinical practice. Trigeminal autonomic cephalalgias (TACs) constitute a relatively uncommon group of primary headache disorders. The term first coined by Goadsby and Lipton now includes four types of primary headache disorders, namely cluster headache (CH), paroxysmal hemicrania (PH), short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral headache attacks with autonomic features (SUNA) (under short-lasting unilateral neuralgiform headache attacks), and hemicrania continua (HC). The rationale for including all these headache disorders in one group stems from the fact that they have two features in common: short-lasting, unilateral, extremely severe headache attacks accompanied by typical ipsilateral cranial autonomic symptoms (CAS). The fourth group namely HC which was the last to be included is characterized by continuous side-locked headache with exacerbations and ipsilateral CAS, especially during the exacerbations. Apart from these phenotypic similarities, the groups differ substantially in terms of demographics, other clinical features, and treatment. Functional neuroimaging has shown the involvement of posterior hypothalamus in these headaches which is taken as a supportive evidence for grouping them together and linking them pathophysiologically. However, the changes in functional neuroimaging are neither universal nor exclusive. Understanding of the pathophysiology of TACs is still evolving. Because of relative rarity of these disorders, often, the diagnosis is delayed and patients are not provided with the optimum treatment. On the other hand, these headache disorders are considered by many as the worst pain conditions known to humankind. Therefore, there is need for greater awareness of these disorders.

This issue focuses exclusively on TACs to provide the latest update and clear concepts about the diagnosis and management of these disorders. We have assembled a group of world-class headache specialists and educators from UK, USA, Germany, and India and tried to create a remarkable volume with the aim to assist neurologists in the evaluation, diagnosis, and management of TACs.

The issue begins with a set of articles discussing a broad overview of the concept of TACs and the latest classification system. Professor Peter Goadsby, an authority on TACs, and his colleagues Dr. Diana Yi-Ting Wei and Dr. Jonathan Jia Yuan Ong first provide us a comprehensive overview of the emergence of the concept of TACs and a critique of the rationale of how the various entities were included in this group. Dr. K Ravishankar, a well-known senior headache specialist from India, next discusses the current diagnostic criteria of TACs comparing it to previous classifications, detailing the changes that have been made and their implications. Professor Peter Goadsby and his team again share their expertise and experience by reviewing the epidemiology, pathophysiology, clinical features, and diagnosis of CH in a comprehensive manner. In the next article, Dr. William S Kingston and Professor David Dodick, an authority on headache disorders, discuss the treatment of CH in a lucid and practical way highlighting the evidence base (and lack of it) and the newer treatments that are in the pipeline. In the next article, Dr. Anish Bahra and Dr. Chinar Osman succinctly review PH and its management and share their expertise on the use of indomethacin for diagnosis and management of this disorder. Dr. Manjit Matharu, a reputed researcher in the field of TACs, and his colleague Dr. Andrew Levy discuss the uncommon and the most enigmatic entity among the TACs, namely SUNCT and SUNA, and provide the latest update on the subject including the controversies. Dr. Sanjay Prakash, a well-known headache researcher from India, and his colleague Dr. Bansi Adroja next review comprehensively HC with emphasis on differential diagnosis and management. This is followed by a very informative article by Dr. Mark Oberman and his colleagues Dr. Dagney Holly and Dr. Steffen Nagel, discussing functional neuroimaging in TACs with implications for pathophysiology and potential applications in clinical practice. Dr. Mark Oberman is known for his expertise in the field of neuroimaging in headache disorders. The issue ends with a review article on secondary TACs by me where I have tried to critically analyze the concept and nomenclature of secondary TACs and give an update on the recently described cases.

In summary, this is a comprehensive update issue on TACs, and I hope that readers will find the articles useful and stimulating.


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