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PreCourse 8: Real-World Pharmacologic Management in Headache Disorders: Navigating Clinical Grey Zones

Session: PreCourse 8: Real-World Pharmacologic Management in Headache Disorders: Navigating Clinical Grey Zones - Presented by the CSF Pressure and Volume Disorders SIG & Pharmacology and Therapeutics SIG

TACs and Pharmacological Considerations

Thursday, December 4, 2025

2:55 PM - 3:20 PM MST

Location: Rainmakers Ballroom

Faculty(s)

Michael J. Marmura, MD

Professor of Neurology
Thomas Jefferson University
Philadelphia, Pennsylvania, United States

The treatment of trigeminal autonomic neuralgias requires facility in using uncommonly utilized off-label medications with potential for significant adverse events. This review will describe the use of older medications such verapamil and lithium and corticosteroids for cluster headache, the use of indomethacin and alternatives for TACs, and the management of SUNCT/SUNA syndromes. This discussion will focus on practical concerns which occur in clinical practice, and the monitoring required to use these treatments safely.

Learning Objectives:

Review strategies for safely and effectively using older medications such as corticosteroids, verapamil and lithium in patients with cluster headache.
Discuss protocols for initiating therapy for potentially indomethacin-responsive headache disorders and alternatives for those who cannot use it.
Identify potentially effective treatments for patients with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA.)