Who Is at Risk for TACs?

Nov 02, 2023
Who Is at Risk for TACs?
If you've ever experienced a cluster headache, you're familiar with one of the most well-known trigeminal autonomic cephalalgias (TACs). Although rare, these severe headaches can cause significant disability. Learn what increases your risk.

Trigeminal autonomic cephalalgia is a headache disorder characterized by recurrent, often severe, unilateral head pain accompanied by cranial autonomic symptoms such as tearing, nasal congestion, eyelid swelling, and pupil constriction.

That’s the official definition for headaches arising along the trigeminal nerve. What it means is you can expect a debilitating, one-sided, stabbing headache and other symptoms that, depending on the type, may last two minutes to three hours and occur up to 100 times a day.

TACs are often misdiagnosed and difficult to treat. Dr. Wade Steeves at Valley Neurology in Spokane Valley, Washington, is a board-certified neurologist specializing in headache treatment and prevention. 

He’s currently the only neurologist in the region focusing solely on headache management. His expertise includes diagnosing and treating TACs.

Read more from Dr. Steeves and his team about TACs and who’s at risk.

Types of TACs

TACs are separated into types according to their symptoms and include:

Cluster headaches

Cluster headaches are typically recurrent, causing frequent painful attacks (clusters) that can occur several times daily for weeks to months. That’s usually followed by periods of remission that can last for months.

The pain is typically described as severe, sharp, stabbing, or burning. These headaches usually occur in, around, or behind one eye, but the pain can travel to other regions of the face, head, or neck. Each headache episode can last 15 minutes to three hours.

Autonomic symptoms can include eye redness and tearing, nasal congestion or runny nose, drooping eyelid, pupillary constriction, and facial sweating — all on the same side as the headache.

Paroxysmal hemicrania

This type often occurs more frequently than cluster headaches but doesn’t last as long, usually 2 to 30 minutes. The pain is severe and throbbing, generally occurring around the eye or temple, and autonomic symptoms are similar to cluster headaches.


Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) cause short bursts of moderate to severe stabbing or throbbing pain that can occur hundreds of times daily.

Each episode lasts five seconds to four minutes and is accompanied by one-sided eye redness, tearing, and other facial symptoms.

Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) are similar to SUNCT attacks but may not include eye symptoms.

Who’s at risk for TACs?

Unfortunately, it’s not clear what causes TACs, but certain factors may increase your risk, including:

  • Age (more common between 20 and 40)
  • History of TACs in a parent or sibling
  • Prior head injury
  • Irregular sleep patterns
  • Sleep apnea
  • Allergies (sometimes noted as a trigger)

Alcohol consumption is a common trigger for some TACs, namely cluster headaches, but there’s no evidence alcohol use causes the disorder.

There also seems to be a significant association between cluster headaches and smoking. Many people who suffer from these headaches are current or former smokers. However, it's important to note that many non-smokers develop TACs. 

Additionally, while Dr. Steeves certainly recommends it for your overall health, smoking cessation doesn’t resolve cluster headaches.

Treating TACs

Effective treatment for TACs starts with a thorough evaluation that includes a careful review of your symptoms, a physical exam, and neurological testing to determine your headache type.

Dr. Steeves then develops a customized treatment strategy that may include medications, improved sleep, or other therapies to relieve pain and reduce the severity and frequency of TAC attacks.

Schedule an evaluation at Valley Neurology today. Call the office or request an appointment online.