Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
TAC-Tic syndromes: a case series on the complex overlap between trigeminal autonomic cephalalgias and trigeminal neuralgia.
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de Sousa Pelliciari Davy Henrique, Garcia Larissa Aguiar, Bordini Carlos Alberto, Ribeiro Jaqueline Silva
Аннотация
INTRODUCTION: Trigeminal autonomic cephalalgias (TACs) and trigeminal neuralgia (TN) are classified as distinct disorders, although overlap syndromes are increasingly recognized.
CASE REPORTS: We retrospectively describe five women with TAC-tic overlap: two with SUNCT-tic, two with cluster-tic, and one with paroxysmal hemicrania-tic syndrome. Each had distinguishable neuralgic and autonomic pain phenotypes, appearing either simultaneously or sequentially. In both SUNCT-tic cases, repeat imaging disclosed neurovascular compression after an initially negative study; microvascular decompression produced complete remission of both phenotypes. Cluster-tic presentations were controlled with peripheral nerve blocks, carbamazepine, and verapamil. In the paroxysmal hemicrania-tic case, the autonomic component responded to indomethacin whereas the neuralgic component required neuromodulator adjustment.
DISCUSSION: The opposite order of phenotype emergence in the SUNCT-tic cases, together with shifts in the dominant phenotype during treatment, supports bidirectional temporal plasticity. Convergence of trigeminal and upper cervical afferents in the trigeminocervical complex offers a plausible link between peripheral input, the trigeminal-autonomic reflex, and the observed response to occipital nerve blocks.
CONCLUSION: TAC-tic syndromes are rare and probably underrecognized. Repeated phenotyping, imaging tailored to the trigeminal root when clinically indicated, and treatment directed at each component may improve clinical control.
CASE REPORTS: We retrospectively describe five women with TAC-tic overlap: two with SUNCT-tic, two with cluster-tic, and one with paroxysmal hemicrania-tic syndrome. Each had distinguishable neuralgic and autonomic pain phenotypes, appearing either simultaneously or sequentially. In both SUNCT-tic cases, repeat imaging disclosed neurovascular compression after an initially negative study; microvascular decompression produced complete remission of both phenotypes. Cluster-tic presentations were controlled with peripheral nerve blocks, carbamazepine, and verapamil. In the paroxysmal hemicrania-tic case, the autonomic component responded to indomethacin whereas the neuralgic component required neuromodulator adjustment.
DISCUSSION: The opposite order of phenotype emergence in the SUNCT-tic cases, together with shifts in the dominant phenotype during treatment, supports bidirectional temporal plasticity. Convergence of trigeminal and upper cervical afferents in the trigeminocervical complex offers a plausible link between peripheral input, the trigeminal-autonomic reflex, and the observed response to occipital nerve blocks.
CONCLUSION: TAC-tic syndromes are rare and probably underrecognized. Repeated phenotyping, imaging tailored to the trigeminal root when clinically indicated, and treatment directed at each component may improve clinical control.