Cluster headache beyond the pain phase

Snoer, Agneta; Lund, Nunu; Beske, Rasmus Paulin; Hagedorn, Andreas; Jensen, Rigmor Højland; Barloese, Mads

doi:10.1212/01.wnl.0000542491.92981.03

Cited by 36 publications

(30 citation statements)

References 38 publications

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“…Data on demographics and epidemiology (male to female ratio, eCH to cCH ratio, diagnostic delay) as well as clinical characteristics (pain features and accompanying CAS symptoms) are in line with results of other published CH surveys, 7 thereby confirming the external validity of our data.…”

Section: Discussionsupporting

confidence: 89%

“…The survey is the largest conducted in Germany among cluster headache patients to date, and this paper is the only one to describe detailed pain location patterns in CH patients. Comparable survey-based studies with a different focus have been conducted in the US, 2,12 Germany, 4 France, 1 Denmark, 7,9 the Netherlands, 10 and frequency with which pain locations are reported in the three aspects of CH attacks. Dorsal pain is mainly associated with onset of an attack and with radiating pain, and less frequently reported for peak pain.…”

Section: Discussionmentioning

confidence: 99%

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Pain localization in cluster headache patients: Onset, peak, and radiation

Schröder

Gaul

Drabik³

et al. 2021

Acta Neurol Scand

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Although cluster headache (CH) has been known for many years, major CH surveys with emphasis on pain localization are rare. 1-4 Results from previous international cross-sectional surveys on CH describe demographics, 2,5,6 clinical characteristics including symptoms and personal burden, 2,4,6-9 and diagnostic and therapeutic challenges. 8,10-12 Current pharmaceutical management of CH 13-15 including acute and preventive treatment involves substances 13,16 which, especially when used in high doses over long

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Pain localization in cluster headache patients: Onset, peak, and radiation

Schröder

Gaul

Drabik³

et al. 2021

Acta Neurol Scand

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“…Conjunctival injection and/or lacrimation has been consistently reported to be the most common CAS in individuals with CH [8,[28][29][30]. In the present study, conjunctival injection and/or lacrimation, as the most frequent CAS, was observed in 86.6% of participants with CH.…”

Section: Discussionsupporting

confidence: 56%

“…A prospective clinical study in the UK found that 76% of individuals with CH had ptosis [30]. A Danish study reported that ptosis was present in 44.8% of patients with CH [29]. In Asian studies, a lower frequency of ptosis or miosis has been observed-a Japanese study showed a ptosis frequency of 8.1% [6], while a study at a Chinese tertiary headache centre revealed that ptosis or miosis was present in 16.7% of patients with CH [32] and a Korean multicentre study reported a rate of 8.5% [31].…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of Cluster Headache without Cranial Autonomic Symptoms: Results from a Prospective multicentre study

Chu

Kim

Chung

et al. 2020

Preprint

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Background: Although cranial autonomic symptoms are typical in cluster headache, some individuals with cluster headache show no cranial autonomic symptoms during their headache attacks. Probable cluster headache is a subtype of cluster headache that fulfils all but one of the five criteria for cluster headache. This study aimed to investigate the frequency and clinical features of cluster headache and probable cluster headache without cranial autonomic symptoms in comparison to those with cranial autonomic symptoms.Methods: We analysed data from the Korea Cluster Headache Registry, a prospective multicentre registry involving data from 16 hospitals.Results: Of the 216 participants with cluster headache and 26 with probable cluster headache, 19 (8.8%) and 7 (26.9%), respectively, did not have cranial autonomic symptoms. Participants with cluster headache without cranial autonomic symptoms exhibited less severe anxiety (General Anxiety Disorder-7 score, median [interquartile range], 2.0 [1.0-6.0] vs 8.0 [3.0-12.0], p = 0.001) and depression (Patient Health Questionnaire-9 score, 3.0 [1.0-7.0] vs 7.0 [3.0-11.0], p = 0.042) than those with cranial autonomic symptoms. Other clinical features, including headache intensity, daily headache frequency, attack duration, bout duration, and location of the pain, did not differ between participants with cluster headache with and without cranial autonomic symptoms. Headache intensity was less severe in participants with probable cluster headache without cranial autonomic symptoms than in those with cranial autonomic symptoms (numeric rating scale, 8.0 [7.0-8.0] vs 9.5 [8.0-10.0], p = 0.015).Conclusions: A significant proportion of participants with cluster headache and probable cluster headache did not have cranial autonomic symptoms. Some clinical features of cluster headache and probable cluster headache differed based on the presence of cranial autonomic symptoms.

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“…CH attacks triggered experimentally by pharmacological substances are not spontaneous and therefore do not fulfil strict International Headache Society (IHS) CH attack criteria (17). Since we have demonstrated that CH patients become aware of the attack early in its course (19), we cannot ethically deny them treatment for the attack. We define an experimentally induced cluster-like attack as follows.…”

Section: Methodsmentioning

confidence: 99%

The effect of pituitary adenylate cyclase-activating peptide-38 and vasoactive intestinal peptide in cluster headache

et al. 2020

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Background Previously reported increases in serum levels of vasodilating neuropeptides pituitary adenylate cyclase-activating peptide-38 (PACAP38) and vasoactive intestinal peptide (VIP) during attacks of cluster headache could indicate their involvement in cluster headache attack initiation. We investigated the attack-inducing effects of PACAP38 and vasoactive intestinal peptide in cluster headache, hypothesising that PACAP38, but not vasoactive intestinal peptide, would induce cluster-like attacks in episodic active phase and chronic cluster headache patients. Methods In a double-blind crossover study, 14 episodic cluster headache patients in active phase, 15 episodic cluster headache patients in remission phase and 15 chronic cluster headache patients were randomly allocated to receive intravenous infusion of PACAP38 (10 pmol/kg/min) or vasoactive intestinal peptide (8 pmol/kg/min) over 20 min on two study days separated by at least 7 days. We recorded headache intensity, incidence of cluster-like attacks, cranial autonomic symptoms and vital signs using a questionnaire (0–90 min). Results In episodic cluster headache active phase, PACAP38 induced cluster-like attacks in 6/14 patients and vasoactive intestinal peptide induced cluster-like attacks in 5/14 patients ( p = 1.000). In chronic cluster headache, PACAP38 and vasoactive intestinal peptide both induced cluster-like attacks in 7/15 patients ( p = 0.765). In episodic cluster headache remission phase, neither PACAP38 nor vasoactive intestinal peptide induced cluster-like attacks. Conclusions Contrary to our hypothesis, attack induction was lower than expected and roughly equal by PACAP38 and vasoactive intestinal peptide in episodic active phase and chronic cluster headache patients, which contradicts the PAC1-receptor as being solely responsible for attack induction. Trial registration: clinicaltrials.gov (identifier NCT03814226).

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Cluster headache beyond the pain phase

Cited by 36 publications

References 38 publications

Pain localization in cluster headache patients: Onset, peak, and radiation

Pain localization in cluster headache patients: Onset, peak, and radiation

Clinical Features of Cluster Headache without Cranial Autonomic Symptoms: Results from a Prospective multicentre study

The effect of pituitary adenylate cyclase-activating peptide-38 and vasoactive intestinal peptide in cluster headache

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