Diagnostic delay of cluster headache: A cohort study from the Danish Cluster Headache Survey

Abstract

Aim To investigate the influence of clinical and demographic features on diagnostic delay in cluster headache patients, in order to discuss diagnostic pitfalls and raise disease awareness. Methods A large, well-characterized cohort of 400 validated cluster headache patients from the Danish Cluster Headache Survey, diagnosed according to ICHD-II, were investigated. ANOVA was applied to investigate differences in diagnostic delay between groups. Selected independent variables were assessed in relation to diagnostic delay using a gamma regression model. Results Diagnostic delay was significantly reduced for each decade of cluster headache onset from 1950–2010 ( p < 0.001). Onset after 1990 was associated with shorter diagnostic delay (OR = 0.28, p < 0.001), whereas attack duration > 180 minutes (OR = 1.62, p < 0.034), migraine-like features (OR = 1.30, p < 0.043) and nocturnal attacks (OR = 1.39, p < 0.021) were associated with prolonged diagnostic delay. Further, diagnostic delay decreased with age of onset (age < 20: 13.8 years, age 20–40: 5.4 years and age > 40: 2.1 years, p < 0.001). Conclusion Diagnostic delay was reduced for every decade investigated, whereas some atypical cluster headache features were associated with prolonged diagnostic delay. Better medical education and more disease awareness are needed to prevent misdiagnosis and prolonged diagnostic delay.

Episodic and Chronic Cluster Headache: Differences in Family History, Traumatic Head Injury, and Chronorisk

“…eCH patients had 1.9 ± 3.1 cluster/year (median = 1, [0.75, 2.0]) lasting 8.3 ± 6.4 weeks (median = 7, [4, 12]). Lifestyle and diagnostic factors for these patients have previously been reported …”

“…The remainder has already been published or is in the publication process. This includes sleep and chronobiology, gender differences, lifestyle, diagnostic delay, and assessment of chronorisk …”

“…They were matched for sex and age (mean values) and were excluded if they had primary headache more than 1 day/month. The dataset used in this publication is identical to our group’s previous study . The original aim of the Danish Cluster Headache Survey was to detect differences in the presence of sleep disorders between CH patients and controls with an a priori hypothesis that the prevalence was higher in CH patients.…”

“…The remainder has already been published or is in the publication process. This includes sleep and chronobiology, 3 gender differences, 6 lifestyle, 7 diagnostic delay, 8 and assessment of chronorisk. 9 In the questionnaire containing 362 questions on subjects pertaining to diagnosis, treatment, sleep, burden, and lifestyle patients were also asked to indicate family members with CH including brothers, sisters, sons, daughters, mother, father, and grandparents (both sides).…”

“…The dataset used in this publication is identical to our group's previous study. 7,8 The original aim of the Danish Cluster Headache Survey was to detect differences in the presence of sleep disorders between CH patients and controls with an a priori hypothesis that the prevalence was higher in CH patients. To this aim, a power calculation suggested that 109 subjects should be included in each group.…”