Differences in Characteristics and Comorbidity of Cluster Headache According to the Presence of Migraine

Abstract

Background and Purpose Cluster headache (CH) can present with migrainous symptoms such as nausea, photophobia, and phonophobia. In addition, an overlap between CH and migraine has been reported. This study aimed to determine the differences in the characteristics of CH according to the presence of comorbid migraine. Methods This study was performed using data from a prospective multicenter registry study of CH involving 16 headache clinics. CH and migraine were diagnosed by headache specialists at each hospital based on third edition of the International Classification of Headache Disorders (ICHD-3). We interviewed patients with comorbid migraine to obtain detailed information about migraine. The characteristics and psychological comorbidities of CH were compared between patients with and without comorbid migraine. Results Thirty (15.6%) of 192 patients with CH had comorbid migraine, comprising 18 with migraine without aura, 1 with migraine with aura, 3 with chronic migraine, and 8 with probable migraine. Compared to patients with CH without migraine, patients with CH with comorbid migraine had a shorter duration of CH after the first episode [5.4±7.4 vs. 9.0±8.2 years (mean±standard deviation), p =0.008], a lower frequency of episodic CH (50.0% vs. 73.5%, p =0.010), and a higher frequency of chronic CH (13.3% vs. 3.7%, p =0.033). Psychiatric comorbidities did not differ between patients with and without comorbid migraine. The headaches experienced by patients could be distinguished based on their trigeminal autonomic symptoms, pulsating character, severity, and pain location. Conclusions Distinct characteristics of CH remained unchanged in patients with comorbid migraine with the exception of an increased frequency of chronic CH. The most appropriate management of CH requires clinicians to check the history of preceding migraine, particularly in cases of chronic CH.

Erenumab Efficacy on Comorbid Cluster Headache in Patients With Migraine: A Real‐World Case Series

“…If, on one hand, CH patients (up to 46%) can show migraine‐like features and a large proportion of migraine patients can experience typical trigeminal‐autonomic symptoms, 15,16 on the other hand about one‐fourth of CH patients show an additional migraine diagnosis. Interestingly, the prevalence of migraine comorbidity is 15.6% in all CH patients (40% in patients with chronic CH) 17 …”

Morning Headache as an Obstructive Sleep Apnea-Related Symptom among Sleep Clinic Patients—A Cross-Section Analysis

“…MH has been considered to be a symptom of OSAS for more than a century [6,7]. The importance of the link is reflected in the 3rd edition of the International Classification of Headache Disorders since it provides diagnostic criteria for OSAS related headache.…”

“…It is hypothesized that the sensation of pain appears due to consequences of repeating apneas, which include hypoxemia reflected by decrement in blood oxygen saturation (SpO 2 ) and cerebral vasodilation due to a rise in carbon dioxide partial pressure, but also sleep fragmentation. However, the exact cause of this type of headache still remains unclear [6,7]. The most extensively studied epidemiological association in OSAS patients was between headaches and snoring [10,11].…”

Chronic Cluster Headache with a Pediatric Onset: The First Japanese Case Report

“…CH can have migrainous features, such as nausea, vomiting, photophobia, and phonophobia, in both adult and pediatric patients; among the latter, the occurrence of migrainous features is a major source of misdiagnosis as migraine, which is far more common than CH among pediatric patients ( 20 ). In a Korean study, the CCH subtype appeared more often with comorbid migraine, which may increase the speed and ease of diagnosis ( 21 ). The lower prevalence of CCH in Asian patients may be due to racial, lifestyle, or cultural factors.…”