Trigeminal autonomic cephalalgias present with excruciating headaches and accompanying autonomic features such as ipsilateral lachrymation, rhinorrhoea, and eyelid ptosis. For clinical purposes, these headaches are subclassified into cluster headaches, paroxysmal hemicranias, and the SUNCT syndrome (sudden unilateral neuralgiform headache with conjunctival injection and tearing),¹ of which the paroxysmal hemicrania subtypes such as the acute and chronic hemicranias are indomethacin responsive. Neuroimaging is often normal in trigeminal autonomic cephalalgias; nevertheless MRI should be considered, as there are associations between trigeminal autonomic cephalalgia and multiple sclerosis,² lateral medullary infarction,³ pontine tumours,⁴ basilar aneurysms,⁵ and other posterior fossa lesions. We present an unusual case of recurrent transient ischaemic attacks (TIA) with symptoms reminiscent of a trigeminal autonomic cephalalgia which ceased after a ponto-mesencephalic infarct. …