Short-lasting primary headaches: focus on trigeminal automatic cephalgias and indomethacin-sensitive headaches.

Short-lasting primary headache syndromes provides both a diagnostic challenge and considerable therapeutic reward. Primary short-lasting headaches broadly divide themselves into those associated with auto nomic symptoms, trigeminalautonomic cephalgias and those with little autonomic syndromes. The trigeminal-autonomic cephalgias include cluster headache and paroxysmal hemicranias, in which head pain and cranial autonomic symptoms are prominent. Consideration of short- lasting headaches, particularly in the context of the differential diagnosis between cluster headache and paroxysmal hemicrania leads to a consideration of indomethacin-sensitive headaches. There are a group of headaches, such as paroxysmal hemicrania and hemicrana continua , which have a curious and a very robust response to indomethacin. These headaches tend to be referred to neurologists as they are refractory to other treatments and thus are useful to know about.