Clinical reference · Card 05 of 11 · Differential
Differential — the four trigeminal autonomic cephalalgias
All four share strictly unilateral pain with ipsilateral autonomic features. Duration and frequency separate them; indomethacin confirms two.
SUNCT / SUNA§3.3
DURATION1–600 seconds
FREQUENCY3–200 per day
SEX RATIO~1.5 : 1 M
INDOMETHACINNo response
Paroxysmal hemicrania§3.2
DURATION2–30 minutes
FREQUENCY>5 per day, more than half the time
SEX RATIO~1 : 2 M:F
INDOMETHACINAbsolute response
Cluster headache§3.1
DURATION15–180 minutes
FREQUENCY1 every other day to 8 per day
SEX RATIOMale-predominant
INDOMETHACINNo response
Hemicrania continua§3.4
DURATIONContinuous >3 months
FREQUENCYUnremitting, with exacerbations
SEX RATIOFemale-predominant
INDOMETHACINAbsolute response
THE INDOMETHACIN TRIAL — ICHD-3 §3.2 NOTE“In adults, oral indomethacin should be used initially in a dose of at least 150 mg daily and increased if necessary up to 225 mg daily. The dose by injection is 100–200 mg. Smaller maintenance doses are often employed.”A complete response confirms paroxysmal hemicrania or hemicrania continua and excludes cluster headache. Co-prescribe gastric protection; check renal function and NSAID contraindications first.
Also consider: trigeminal neuralgia (seconds, triggered by touch, V2/V3) · acute angle-closure glaucoma (semi-dilated pupil, not miosis — NICE CG150).
SOURCES ICHD-3, Cephalalgia 2018 §3.1–3.4. Indomethacin: ICHD-3 §3.2 and §3.4 (adults, oral, ≥150 mg daily, reducing to ≥100 mg maintenance).
Cluster headache tracking and analysis for patientsmyclusters.nlGet the printed setAll 11 cards, A6, printed back to back. The print-ready PDF unlocks when you request.