TAC-Tic syndromes: a case series on the complex overlap between trigeminal autonomic cephalalgias and trigeminal neuralgia.
Davy Henrique de Sousa Pelliciari, Larissa Aguiar Garcia, Carlos Alberto Bordini et al.
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Case in brief
A retrospective case series described five women with overlapping trigeminal autonomic cephalalgias and trigeminal neuralgia: two SUNCT-tic, two cluster-tic, and one paroxysmal hemicrania-tic syndrome. Each had distinguishable autonomic and neuralgic pain features, occurring together or at different times. In the SUNCT-tic cases, repeat imaging showed neurovascular compression despite an initially negative study, and microvascular decompression led to complete remission of both pain phenotypes. The other cases were controlled with combinations of nerve blocks and medication, or with treatment directed separately at the autonomic and neuralgic components.
What made this case unusual
In both SUNCT-tic cases, neurovascular compression became apparent only on repeat imaging after an initially negative study; decompression was followed by remission of both pain phenotypes.
Diagnostic / clinical pearl
When TAC and neuralgic features coexist, characterize each pain phenotype repeatedly. If clinically indicated, imaging focused on the trigeminal root may reveal neurovascular compression not seen initially.
Why it matters
The series highlights that the two pain components may emerge in different sequences or shift in dominance during treatment, supporting assessment and management directed at each component.