FFS: Headache – Neuralgic Chart

Clinical Feature	Primary Stabbing (Ice Pick)	Trigeminal Neuralgia	Cluster Headache	Paroxysmal Hemicrania / Hemicrania Continua	SUNCT	SUNA
Epidemiology	Children & adults	Typically >55 years	Males > females	PH: Females = males; HC: Females > males	Females = males	Females = males
Nature	Stabbing	Electric shocks	Stabbing, boring	Stabbing, boring, throbbing	Burning, stabbing, sharp	Burning, stabbing, sharp
Location	Anywhere, mainly extra-trigeminal; may change site	Strictly unilateral; V2–3 > V1	Unilateral; frontal / temporal	Unilateral; frontal / temporal; intensity may vary	Unilateral; V1	Unilateral; V1
Duration	Seconds	Seconds – 2 minutes	15 min – 3 hours	2 – 30 minutes (PH); continuous (HC)	5 sec – 4 min	5 sec – 4 min
Frequency	Single stabs or volleys	Episodic weeks–months with pain-free intervals	1–8/day	PH: 1–40/day; HC: >3 months	3–200/day	3–200/day
Triggers	None	Cutaneous, movement	Variable	No	Yes	Yes
Autonomic Features*	No	No	Yes	Yes (prominent)	Yes	Yes
Possible Structural Cause	Idiopathic	Yes	Idiopathic	Idiopathic	Idiopathic	Idiopathic
First-line Therapy	Indomethacin (variable response)	Carbamazepine / oxcarbazepine	Triptans, oxygen	Indomethacin (100% response)	Lamotrigine, gabapentin, topiramate	Lamotrigine, gabapentin, topiramate

Notes:

• PH = Paroxysmal Hemicrania
• HC = Hemicrania Continua
• SUNCT = Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing
• SUNA = Short-lasting Unilateral Neuralgiform headache attacks with Autonomic symptoms

Autonomic features may include:

• Rhinorrhoea
• Lacrimation
• Conjunctival injection
• Ptosis
• Miosis
• Flushing
• Sweating

Despite overlapping features, TACs differ in attack duration, frequency, and response to therapy.

Primary stabbing headache may occur within or outside the trigeminal distribution, distinguishing it from trigeminal neuralgia.

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References

Publications

• Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. 
• Brazis PW, Masdeu JC, Biller J. Localization in Clinical Neurology. 8e 2021
• Fuller G. Neurological Examination Made Easy. 6e 2019

FOAMed

• Coni R. Trigeminal autonomic cephalalgias. LITFL
• Coni R. Other primary headaches. LITFL
• Coni R. Characterising headache. LITFL
• Coni R. Headache classification. LITFL
• Coni R. Headache Essentials. LITFL