cqvip:We report headache induced BOLD changes in an atypical case of trigeminal auto nomic cephalgia (TAC). A 68 year old patient was imaged using fMRI during thre e attacks of a periorbital head pain with a average duration of 3 min. During t he attacks, left sided conjunctival injection, rhinorrhea, lacrimation, facial s weating and hypersalivation were apparent. These attacks were usually partly res ponsive to oxygen administration but otherwise refractory to any drug. The patie nt described either attacks with a duration of one minute or less or longer atta cks persisting for maximum of 20 min with headaches occurring up to 100 times a day. When considering the symptoms, frequency, duration and therapeutic response of the patients headache, no clear cut classification to one of the sub typ es of trigeminal autonomic cephalgias (cluster headache, paroxysmal hemicrania, SUNCT) or trigeminal neuralgia was possible. The cerebral activation pattern was similar but not identical to those previously observed in cluster headache and SUNCT with a prominent activation in the hypothalamic grey matter. This case stu dy underlines the conceptual value of the term TAC for the group of headaches fo cusing around the trigeminal autonomic reflex. Our results emphasize the import ance of the hypothalamus as key region in the pathophysiology of this entity.
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