Cluster headache in relation to different age groups

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

doi:10.1007/s10072-019-03767-w

Cited by 13 publications

(13 citation statements)

References 25 publications

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“…Previous studies looked at the fluctuations in the prevalence of the sex distribution across ages: Kudrow reported an increased frequency of CH in women when they reached the age of fifty or sixty (2), and Ebkom and Mosek confirmed an initial onset of CH after the menopause (14, 26). This finding has been recently confirmed, mostly for the chronic form of CH, by Manzoni et al (27), who also noted an increased occurrence of CH in women before the age of 14. These observations fit well with our findings regarding the role of hormones in CH women when considering that several studies have reported a tendency toward a bimodal distribution of age at onset of CH in women (2nd−3rd decade and 5th−6th decade) (8, 25), while CH onset in men manifests peaks during the 3rd decade (8).…”

Section: Discussionsupporting

confidence: 69%

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: 69%

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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“…2 CH is more prevalent in the workforce, 3 with a mean age at onset around 30 years and an established male predominance. 4,5 Despite its low prevalence compared with migraine and tension-type headache, 6 CH is a debilitating primary headache disorder with substantial personal and healthcare impact that requires effective treatment and prevention. 7,8 Preventive medications (verapamil and lithium are considered the primary options) present a number of contraindications and adverse events that may impede their use, while many cases prove refractory to the initial approach and require the administration of additional medications, warranting the investigation for additional candidates to enhance our armamentarium in the management of CH.…”

Section: Introductionmentioning

confidence: 99%

“…CH is more prevalent in the workforce, 3 with a mean age at onset around 30 years and an established male predominance 4,5 . Despite its low prevalence compared with migraine and tension‐type headache, 6 CH is a debilitating primary headache disorder with substantial personal and healthcare impact that requires effective treatment and prevention 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Meta‐analysis of melatonin levels in cluster headache—Review of clinical implications

et al. 2020

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Cluster headache (CH) has been associated with circadian disturbances. The present systematic review examined available evidence for the utilization of melatonin (MT) in CH prophylaxis. First, case‐control studies assessing nocturnal MT or its urine‐expelled metabolite 6‐sulfatoxymelatonin (aMT6s) in CH individuals and healthy controls (HC) were reviewed and meta‐analyzed. Secondly, the results from randomized controlled trials (RCTs) and non‐randomized studies evaluating MT’s use in the prevention of CH were discussed. Literature search included MEDLINE, EMBASE, CENTRAL, PsycINFO, trial registries, Google Scholar, and OpenGrey. Bouts and remissions were assessed separately. Ten case‐control studies (adult participants) were retrieved. Seven evaluated serum MT; meta‐analysis involved only three of them (due to deficient reporting, n: bout = 31, remission = 38, HC = 31). Results were compatible with lower nocturnal serum MT levels during bouts [bout‐HC; FE‐MD = −29.89 pg/mL, 95% CI = (−46.00, −13.78), remission‐HC; FE‐MD = −2.40 pg/mL, 95% CI = (−16.57, 21.38), bout‐remission; RE‐MD = −32.10 pg/mL, 95% CI = (−56.78, −7.42)]. Nocturnal urinary melatonin was appraised in two studies, but reporting issues impeded the capitalization of the results. Nocturnal urine aMT6s was evaluated by two studies (n: bout = 29, remission = 22, HC = 20), and pooled results were indicative of lower aMT6s concentration in CH individuals during both active and inactive periods [bout‐HC; FE‐MD = −9.63 μg/nocturnal urine collection, 95% CI = (−14.40, −4.85), remission‐HC; FE‐MD = −9.12 μg/nocturnal urine collection, 95% CI = (−14.63,‐3.62), bout‐remission; FE‐MD = −0.58 μg/nocturnal urine collection, 95% CI = (−4.58, 3.42)]. Regarding CH prophylaxis, one RCT and two non‐randomized trials were retrieved, involving a total of 41 adult CH individuals (11—episodic, 31—chronic) and rendering the deduction of any conclusions precarious. Overall, available data for the role use of MT in CH are insufficient and inconclusive. Complementary studies evaluating endogenous MT concentrations and MT administration to patients with CH are warranted.

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“…The underlying etiopathogenesis of CH remains largely indeterminate. It is reported that CH is driven by various factors, including race (Rozen et al, 2001;Mengistu and Alemayehu, 2013), gender (Rozen et al, 2001;Chung et al, 2019), and age (Manzoni et al, 2016(Manzoni et al, , 2019 as well as genetics (Russell, 2004;Cruz et al, 2013). Among all the factors, the genetic factors showed strong association with the occurrence of CH Studies have discovered a familial aggregation of CH (Cruz et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

No Association Between G1246A Polymorphism in HCRTR2 Gene and Risk of Cluster Headache: Evidence From an Updated Meta-Analysis of Observational Studies

Yang

et al. 2020

Front. Genet.

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Background: The hypocretin receptor 2 (HCRTR2) gene may play a pathological role in cluster headache (CH). However, the conclusions of published reports on the relationship between the G1246A polymorphism (rs2653349) in the HCRTR2 gene and risk of CH remain controversial. This purpose of this article is to comprehensively study the current evidence and assess the association between G1246A polymorphism (rs2653349) in the HCRTR2 gene and risk of CH.Materials and Methods: Four electronic databases—ISI Web of Science, CNKI, PubMed, and EMBASE—were comprehensively searched on August 2020 to find and pinpoint all observational articles related to this study. The association between G1246A polymorphism in the HCRTR2 gene and risk of CH under five different genetic models was evaluated based on the summary odds ratio and corresponding 95 confidence interval (95% CI). Methodological quality was assessed based on the Newcastle–Ottawa Scale (NOS). To assist the analysis, RevMan 5.3 software was used to perform subgroup and sensitivity analyses. Egger's and Begg's tests were then conducted to evaluate and assess publication bias. Finally, a meta-regression was carried out by residual (restricted) maximum likelihood (REML).Results: Eight observation studies containing 3,161 healthy controls and 1,964 patients with CH were identified and to be used for the meta-analysis. With methodological quality NOS assessment, the incorporated studies showed an average score of 6.4 stars. The pooled data didn't support the association between G1246A polymorphism in the HCRTR2 gene and CH vulnerability in the overall population (OR: 0.85, 95% CI 0.69, 1.03; p = 0.10). Subgroup analysis by ethnicity showed no significant association between G1246A and CH in either Caucasians (OR: 0.89, 95% CI 0.77, 1.01; p = 0.08) or Asians (OR: 1.65, 95% CI 0.80, 3.41; p = 0.18). The robustness of the conclusion was tested and confirmed with the leave-one-out sensitivity analysis. Meta-regression analysis showed that chronological order of publication appeared to be significantly associated with the heterogeneity (t = 2.47, p = 0.039; residual I2 = 0%, adjusted R2 = 100%).Conclusion: Our present study showed that the G1246A polymorphism in the HCRTR2 gene did not appear to be an accomplice and associated with CH predisposition among either the Asian or Caucasian population.

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Cluster headache in relation to different age groups

Cited by 13 publications

References 25 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?

Meta‐analysis of melatonin levels in cluster headache—Review of clinical implications

No Association Between G1246A Polymorphism in HCRTR2 Gene and Risk of Cluster Headache: Evidence From an Updated Meta-Analysis of Observational Studies

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