Diagnosis, pathophysiology, and management of cluster headache

Hoffmann, J.; May, Arne

doi:10.1016/s1474-4422(17)30405-2

Cited by 219 publications

(235 citation statements)

References 129 publications

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“…For instance, CH attacks have a typical circadian and circannual periodicity, and the hypothalamus is the main seat of biorhythm regulation . In addition, functional neuroimaging studies have shown an activation of the posterior hypothalamus during CH attacks . Furthermore, hypothalamic deep brain stimulation, though not currently recommended due to severe adverse effects, has been found to be effective for chronic drug‐resistant CH and is also able to modulate thermal and pressure thresholds in CH …”

Section: Discussionmentioning

confidence: 99%

Widespread Hypersensitivity to Pressure Pain in Men With Cluster Headache During Prolonged Remission Is Not Related to the Levels of Depression and Anxiety

et al. 2019

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Background Diminished pressure pain thresholds (PPTs) have been found in patients with cluster headache (CH), suggesting the presence of central sensitization. However, it is not known whether sensitization persists over time during the asymptomatic periods. Objective To investigate if men with episodic CH in a long‐lasting remission phase exhibit widespread pressure pain hypersensitivity. Methods Forty men with episodic CH and 40 matched controls were enrolled. PPTs were assessed bilaterally over 1 trigeminal (temporalis muscle) and 3 extra‐trigeminal points (C5/C6 zygapophyseal joint, second metacarpal, tibialis anterior muscle) by a blinded assessor. Patients were assessed in a prolonged remission phase, at least 6 months after their last CH attack and without taking any medication. Depression and anxiety levels were assessed with the Hospital Anxiety and Depression Scale (HADS). For each point, differences in PPTs were evaluated with a multivariate mixed‐model analysis of covariance test, with side and group as main factors and depression and anxiety levels as covariates. Results PPTs were significantly decreased bilaterally over the temporalis muscle (mean difference: 85 to 100 kPa), C5/C6 zygapophyseal joint (mean difference: 65 to 80 kPa), second metacarpal (mean difference: 65 to 90 kPa), and tibialis anterior muscle (mean difference: 135 to 155 kPa) in patients with CH when compared to headache‐free subjects (all, P < 0.001). No effect of anxiety or depression levels was found. Conclusions Patients with CH exhibited bilateral widespread hypersensitivity to pressure pain during long‐lasting remission periods, which was not associated with depression or anxiety. These results support the persistence of central sensitization in episodic CH, even in remote asymptomatic phases.

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Section: Discussionmentioning

confidence: 99%

Widespread Hypersensitivity to Pressure Pain in Men With Cluster Headache During Prolonged Remission Is Not Related to the Levels of Depression and Anxiety

et al. 2019

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“…The hypothalamus is thought to be involved in the pathogenesis of CH. 6 Interestingly, the male to female ratio decreased from 5~7:1 before 1970s to ~2:1 in the 1990s and afterward in Western studies. Other factors such as environmental, behavioral, and psychosocial factors may be involved in male predominance.…”

Section: Introductionmentioning

confidence: 94%

Differences of Cluster Headache on the Basis of Sex in the Korean Cluster Headache Registry

et al. 2019

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Background Most of the clinical characteristics of cluster headache (CH) have been established through the observation of men with CH. Epidemiological data of CH in women are scarce especially in the Asian population. Here, we sought to assess the prevalence and clinical characteristics of women with CH in comparison to men in a prospective CH registry. Methods Data used in this study were obtained from the Korean Cluster Headache Registry, a prospective, cross‐sectional, multicenter headache registry that collected data from consecutive patients diagnosed with CH. Demographics and clinical characteristics were compared between the sexes. Results In total, 250 patients were enrolled in this study; 41 (16.4%) were women (male to female ratio 5.1:1). Mean age of onset did not differ between women and men (30.7 ± 15.5 vs 29.0 ± 11.1 years). The clinical features of CH in women and men were similar, with no differences in pain severity, duration, and attack frequency. Among autonomic features, facial and forehead sweating was significantly rare in women (4.9%) compared to men with CH (33.0%). Headache‐related disability assessed by Headache Impact Test‐6 did not differ between the sexes; however, depression scale assessed by Patients Health Questionnaire‐9 (11.0 ± 8.5 vs 7.0 ± 5.8, P = .009) and stress (Perceived Stress Scale 4, 7.5 ± 3.4 vs 6.4 ± 3.0, P = .045) were significantly higher in women with CH. Conclusions Although decreasing male preponderance was suggested in recent Western CH studies, CH in women is still far less prevalent than in men in the Korean population. Clinical and demographic characteristics were similar between the sexes. However, psychiatric comorbidities might be highly associated in women with CH.

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“…Cluster headache (CH) refers to trigeminal autonomic cephalalgia characterized by recurrent, severe unilateral pain and ipsilateral autonomic symptoms and has a negative impact on patient life [1]. Previous studies have shown that patients with CH report restrictions in daily living, difficulties in social-activity participation, family life, and housework; and overall life changes [2, 3].…”

Section: Introductionmentioning

confidence: 99%

Impact of cluster headache on employment status and job burden: a prospective cross-sectional multicenter study

et al. 2018

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BackgroundCluster headaches (CH) are recurrent severe headaches, which impose a major burden on the life of patients. We investigated the impact of CH on employment status and job burden.MethodsThe study was a sub-study of the Korean Cluster Headache Registry. Patients with CH were enrolled from September 2016 to February 2018 from 15 headache clinics in Korea. We also enrolled a headache control group with age-sex matched patients with migraine or tension-type headache. Moreover, a control group including individuals without headache complaints was recruited. All participants responded to a questionnaire that included questions on employment status, type of occupation, working time, sick leave, reductions in productivity, and satisfaction with current occupation. The questionnaire was administered to participants who were currently employed or had previous occupational experience.ResultsWe recruited 143 patients with CH, 38 patients with other types of headache (migraine or tension-type headache), and 52 headache-free controls. The proportion of employees was lower in the CH group compared with the headache and headache-free control groups (CH: 67.6% vs. headache controls: 84.2% vs. headache-free controls: 96.2%; p = 0.001). The CH group more frequently experienced difficulties at work and required sick leave than the other groups (CH: 84.8% vs. headache controls: 63.9% vs. headache-free controls: 36.5%; p < 0.001; CH: 39.4% vs. headache controls: 13.9% vs. headache-free controls: 3.4%; p < 0.001). Among the patients with CH, sick leave was associated with younger age at CH onset (25.8 years vs. 30.6 years, p = 0.014), severity of pain rated on a visual analogue scale (9.3 vs. 8.8, p = 0.008), and diurnal periodicity during the daytime (p = 0.003). There were no significant differences with respect to the sick leave based on sex, age, CH subtypes, and CH recurrence.ConclusionsCH might be associated with employment status. Most patients with CH experienced substantial burdens at work.Electronic supplementary materialThe online version of this article (10.1186/s10194-018-0911-x) contains supplementary material, which is available to authorized users.

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Diagnosis, pathophysiology, and management of cluster headache

Cited by 219 publications

References 129 publications

Widespread Hypersensitivity to Pressure Pain in Men With Cluster Headache During Prolonged Remission Is Not Related to the Levels of Depression and Anxiety

Widespread Hypersensitivity to Pressure Pain in Men With Cluster Headache During Prolonged Remission Is Not Related to the Levels of Depression and Anxiety

Differences of Cluster Headache on the Basis of Sex in the Korean Cluster Headache Registry

Impact of cluster headache on employment status and job burden: a prospective cross-sectional multicenter study

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