Clinical features of cluster headache in relation to age of onset: results from a retrospective study of a large case series

Genovese, Antonio; Taga, Arens; Rausa, Francesco; Quintana, Simone; Manzoni, Gian Camillo; Torelli, Paola

doi:10.1007/s10072-019-03801-x

Cited by 5 publications

(4 citation statements)

References 3 publications

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“…Male CH subjects seem to experience more frequently than women lacrimation and facial sweating (9, 20). In partial agreement with our findings, another Italian group noted a lower occurrence of ptosis, tearing and nasal congestion in a subgroup of males with late onset of CH (12), to suggest a possible role of age on the differential expression of associated symptoms.…”

Section: Discussionsupporting

confidence: 92%

“…On the contrary, Dong et al failed to detect any difference between sexes in a relatively quite large clinical population of CH subjects, which however included a small number of women (11). CH men seem more likely to have cranial autonomic symptoms (9, 12), although these seem to be less pronounced in the subjects who experience a late onset of the disease (12). In contrast with these findings, a larger Danish survey has reported an increased occurrence of ptosis, eyelid edema in CH women when compared to men (4).…”

Section: Introductionmentioning

confidence: 97%

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Gender Differences in the Clinical Presentation of Cluster Headache: A Role for Sexual Hormones?

Allena¹,

Icco

Sances³

et al. 2019

Front. Neurol.

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Introduction: Cluster Headache (CH) is a well-characterized primary headache that mostly affects men, although a progressive decrease in the male-to-female ratio has occurred over time. Available, but partly discordant, data on gender-related differences in CH suggest a more marked overlapping with migraine features in female subjects. The aim of this study is to carefully evaluate the female/male distribution of the typical migraine-associated symptoms and of other features of the disease in a large and well-characterized clinical population of CH subjects.Materials and Methods: We enrolled consecutive CH patients regularly followed at the tertiary Headache Science Center of the IRCCS Mondino Foundation of Pavia (Italy) who attended the Center for a CH bout between September 2016 and October 2018. The subjects were requested to fill in a semi-structured questionnaire focused on the presence of migraine-associated symptoms, familiarity for migraine and, for women, the relationship of CH onset with the reproductive events of their life. These data were compared and integrated with those recorded over time in our clinical database, including demographics and clinical characteristics. The primary outcome was the gender distribution of subjects who satisfied ICHD-III criterion D for migraine-associated symptoms. The secondary outcomes were represented by the gender distribution of individual migraine-associated symptoms and of other disease features included in the questionnaire and/or in the clinical database.Results: Data from 163 males (mean age 41.46 ± 10.37) and 87 females suffering of CH (mean age 42.24 ± 11.95) were analyzed. We did not find a different distribution between sexes as regards the primary outcome measure (F 73.6%, M 65.6%, p = 0.200). However, when we analyzed the occurrence of individual symptoms, nausea and osmophobia were reported more frequently by women (p = 0.048, p = 0.037, respectively). Ptosis and nasal congestion were predominant in females (p = 0.017 and p = 0.01, respectively), while enlarged temporal artery was more frequently reported by men (p = 0.001). Distribution of pain across the head tended to be larger in women, extending more frequently to the zygomatic (p = 0.050), parietal (p = 0.049), and frontal (p = 0.037) regions. Women had a longer mean attack duration (p = 0.004) than men. In CH women the onset of disease often corresponded with moments of important changes in the levels of sexual hormones (menarche, post-partum, menopause). Concomitant thyroid diseases and psychiatric disorders were observed more frequently in women than in men, while snoring and smoking habit was reported by a higher percentage of men than women.Conclusion: We confirmed the presence of distinct gender-related differences in CH and added some novel information that lends credibility to the hypothesis of a closer phenotypical similarity between CH and migraine in the female sex. These observations are relevant for advancing our knowledge on CH pathophysiology, as well as for a more refined diagnostic...

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 97%

Gender Differences in the Clinical Presentation of Cluster Headache: A Role for Sexual Hormones?

Allena¹,

Icco

Sances³

et al. 2019

Front. Neurol.

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“…Most studies included patients aged in their 30s and 40s (with the exception of patients aged in their 50s in Sweden and the Netherlands) (Table 2). Age of onset has been reported as 6-75 years (68,69,(77)(78)(79), with a mean age of 23.6-33.92 years in several countries (7,24,25,35,43,58,59,65,68,69,(77)(78)(79)(80)(81)(82)(83). The mean age at diagnosis ranged from 35.7 to 42.5 years (2,9,25,31), suggesting a delay between onset and diagnosis.…”

Section: Agementioning

confidence: 99%

Epidemiology, burden and clinical spectrum of cluster headache: a global update

Kim,

Choi,

Youn

et al. 2023

Cephalalgia

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Background This narrative review aims to broaden our understanding of the epidemiology, burden and clinical spectrum of cluster headache based on updated findings with a global perspective. Methods We conducted a literature search on the following topics: (a) epidemiology; (b) burden: quality of life, disability, economic burden, job-related burden and suicidality; and (c) clinical spectrum: male predominance and its changes, age, pre-cluster and pre-attack symptoms, aura, post-drome, attack characteristics (location, severity, duration and associated symptoms), bout characteristics (attack frequency, bout duration and bout frequency), circadian and seasonal rhythmicity and disease course. Results New large-scale population-based reports have suggested a lower prevalence than previous estimations. The impact of cluster headache creates a significant burden in terms of the quality of life, disability, economic and job-related burdens and suicidality. Several studies have reported decreasing male-to-female ratios and a wide age range at disease onset. The non-headache phases of cluster headache, including pre-cluster, pre-attack and postictal symptoms, have recently been revisited. The latest data regarding attack characteristics, bout characteristics, and circadian and seasonal rhythmicity from different countries have shown variability among bouts, attacks, individuals and ethnicities. Studies on the disease course of cluster headache have shown typical characteristics of attacks or bouts that decrease with time. Conclusions Cluster headache may be more than a “trigeminal autonomic headache” because it involves complex central nervous system phenomena. The spectrum of attacks and bouts is wider than previously recognised. Cluster headache is a dynamic disorder that evolves or regresses over time.

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“…Results of the Eurolight CH Project showed that the disease can have a huge and potentially irreversible impact on patients' lives even during interictal periods [8]. Considering the gender differences in the clinical presentation of CH, studies have reported that females with CH suffered from increased associated migrainous features, longer duration of untreated attacks, association with hormonal uctuations and tended to have a positive family history of migraine [9][10][11][12][13][14][15][16][17]. It is well-known that headache disorders show geographic and ethnic differences between Asian and Western countries.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Burden of a Large Series with Cluster Headache From Turkey: A Cross-Sectional Study From Headache Centers

Dikmen

Ari

Şahin

et al. 2021

Preprint

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Background: Our purpose was to investigate the demographics, diagnosis patterns, clinical characteristics, triggers, treatment experiences, and personal burden of patients with Cluster headache (CH) in Turkey, a country located between Europe and Asia.Methods: The study is a cross-sectional investigation based on data from eight headache centers in Turkey. All patients completed the semi-structured survey either face to face or by phone interview with a neurologist.Results: A total of 209 individuals with a mean age of 39.8 (11.3) completed the survey (176 males; 188 episodic, 21 chronic). The mean age at disease onset was 28.6 (10.2) years. The diagnostic delay was 4.9 years and misdiagnosis before CH was 57.9%. Of participants, 9.1% reported a positive family history for CH. Male patients with CH showed higher rates for being current smokers in comparison to females (59.7% vs. 24.2%; p<0.0001) and they also had significantly more past history of smoking at the time of first diagnosis (60.8% vs. 21.2%; p<0.0001). Females with CH had a previous diagnosis of migraine more frequently (57.6% vs. 27.3; p=0.001). Attack duration without treatment was significantly longer in female patients with CH compared to males (112 min vs. 87 min; p=0.029). Female participants had more migrainous features (57.6 % vs. 36.9%; p=0.033) and nausea/vomiting (48.5% vs. 30.1%; p=0.045) during their attacks. Only 42.1% of all participants reported satisfying treatment experiences. Of the participants, 85.9 % reported that oxygen was efficient for abortive treatment of CH; however, only 22 % of them had an oxygen tube at home. Female participants, as well as chronic CH patients, reported a higher likelihood of preventive treatment experiences. In this study, 49.3% of all participants appeared to be disabled by their headaches. Over one-quarter percent of our cohort reported that CH caused job-related burden.Conclusion: Remarkable diagnostic delay is an ongoing problem for CH and migraine was the most common misdiagnosis. Nearly half of the patients suffered from a burden of CH regardless of chronicity. Both past abortive and preventive treatment experiences of the participants highlight the insufficient efficacy of available choices and the necessity of more specific treatments for CH.

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Clinical features of cluster headache in relation to age of onset: results from a retrospective study of a large case series

Cited by 5 publications

References 3 publications

Gender Differences in the Clinical Presentation of Cluster Headache: A Role for Sexual Hormones?

Gender Differences in the Clinical Presentation of Cluster Headache: A Role for Sexual Hormones?

Epidemiology, burden and clinical spectrum of cluster headache: a global update

Clinical Characteristics and Burden of a Large Series with Cluster Headache From Turkey: A Cross-Sectional Study From Headache Centers

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