Diagnostic and therapeutic errors in cluster headache: a hospital-based study

Abstract

BackgroundCluster headache (CH) is a severe, disabling form of headache. Even though CH has a typical clinical picture it seems that its diagnosis is often missed or delayed in clinical practice. CH patients may thus face: misdiagnosis, unnecessary investigations and delays in accessing adequate treatment. This study was conducted to investigate the occurrence of diagnostic and therapeutic errors with a view to improving the clinical and instrumental work-up in affected patients.MethodsOur study comprised 144 episodic CH patients: 116 from Italy and 28 from Eastern European countries (Moldova, Ukraine, Bulgaria). One hundred six patients (73.6%) were examined personally and 38 (26.4%) were evaluated through telephone interviews conducted by headache specialists using an ad hoc questionnaire developed by the authors.ResultsThe sample was predominantly male (M:F ratio 2.79:1) and had a mean age of 42.4 ± 9.8 years; approximately 76% of the patients had already consulted a physician about their CH at the onset of the disease. The mean interval between onset of the disease and first consultation at a headache center was 4.1 ± 5.6 years. The patients had consulted different specialists prior to receiving their CH diagnosis: neurologists (49%), primary care physicians (35%), ENT specialists (10%), dentists (3%), etc. Misdiagnoses at first consultation were recorded in 77% of the cases: trigeminal neuralgia (22%), migraine without aura (19%), sinusitis (15%), etc. The average “diagnostic delay” was 5.3 ± 6.4 years and the condition was diagnosed approximately (“doctor delay”: one year). Instrumental and laboratory investigations were carried out in 93% of the patients prior to diagnosis of CH. Some of the patients had never received abortive or preventive medications, either before or after diagnosis. Medical prescription compliance: 88% of the cases.ConclusionsOur results emphasize the need to improve specialist education in this field in order to improve recognition of the clinical picture of CH and increase knowledge of the proper medical treatments for de novo CH. Continuous medical education on CH should target general neurologists, primary care physicians, ENT specialists and dentists. A study on a larger population of CH patients may further improve error-avoidance strategies.

The comorbidity burden of patients with cluster headache: a population-based study

“…Respondents compared with the US population in general rather than matched controls. Data should be interpreted cautiously.Van Alboom, 2009 [9]85 male and female CH patients from 4 Belgian neurology clinicsCross-sectional chart review45% had been diagnosed with migraine, 23% with sinusitis, tooth/jaw problems 23%, trigeminal neuralgia 16%.Average diagnostic delay was reported to be 44 months.Voiticovschi –Iosob, 2014 [23]144 male and female Italian and Eastern European patients with episodic cluster headacheCross-sectional (diagnostic interview and survey)16% of CH patients had previously been diagnosed with sinusitis; 4.2% with dental disorders.Average delay between onset of symptoms and diagnosis in this sample was 5.3 years. 10.4% had consulted an otolaryngologist and 2.8% a dentist.Xie, 2013 [24]26 male and female CH patients identified by survey in tertiary Chinese headache clinicCross-sectional (diagnostic interview)14/26 (54%) were current smokers, 19.2% former and 26.9% nonsmokers.The reported prevalence of smoking in those with CH is in line with that in the general population of Chinese men.…”

Tackling the perils of unawareness: the cluster headache case

“…Consequently, many sufferers may never receive the correct diagnosis and, of those who do, a significant minority still do not receive appropriate treatments [9]. Part of the problem is the lack of training in the medical schools, at the level of general practitioners and even higher, in the neurology specialty.…”

If you want to understand what it really means to live with cluster headache, imagine... Fostering empathy through European patients� own stories of their experiences

“…(Kalina, France). Comments: Despite the disability caused by CH and the availability of effective treatments, it remains an underdiagnosed and undertreated condition (van Vliet et al, 2003, Voiticovschi-Iosob, 2014. Estimated through a nationwide mailing to general practitioners and neurologists, the median time between the first episode and the diagnosis was three years, and ranged from one week to 48 years (van Vliet et al, 2003).…”

“…Estimated through a nationwide mailing to general practitioners and neurologists, the median time between the first episode and the diagnosis was three years, and ranged from one week to 48 years (van Vliet et al, 2003). Overall, less than two in five patients will be correctly diagnosed and two in three will never receive an adequate treatment (Voiticovschi-Iosob et al, 2014). "If you want to understand what it means living with cluster headache you should see my brain.…”