Epidemiology, burden and clinical spectrum of cluster headache: a global update

Abstract

Background This narrative review aims to broaden our understanding of the epidemiology, burden and clinical spectrum of cluster headache based on updated findings with a global perspective. Methods We conducted a literature search on the following topics: (a) epidemiology; (b) burden: quality of life, disability, economic burden, job-related burden and suicidality; and (c) clinical spectrum: male predominance and its changes, age, pre-cluster and pre-attack symptoms, aura, post-drome, attack characteristics (location, severity, duration and associated symptoms), bout characteristics (attack frequency, bout duration and bout frequency), circadian and seasonal rhythmicity and disease course. Results New large-scale population-based reports have suggested a lower prevalence than previous estimations. The impact of cluster headache creates a significant burden in terms of the quality of life, disability, economic and job-related burdens and suicidality. Several studies have reported decreasing male-to-female ratios and a wide age range at disease onset. The non-headache phases of cluster headache, including pre-cluster, pre-attack and postictal symptoms, have recently been revisited. The latest data regarding attack characteristics, bout characteristics, and circadian and seasonal rhythmicity from different countries have shown variability among bouts, attacks, individuals and ethnicities. Studies on the disease course of cluster headache have shown typical characteristics of attacks or bouts that decrease with time. Conclusions Cluster headache may be more than a “trigeminal autonomic headache” because it involves complex central nervous system phenomena. The spectrum of attacks and bouts is wider than previously recognised. Cluster headache is a dynamic disorder that evolves or regresses over time.

The location of pain in cluster headache: Data from the International Cluster Headache Questionnaire

“…Data were collected by a single author (M.J.B.) on October 7, 2022, via a search of six sources: PubMed, Google Scholar, three systematic reviews of cluster headache (family history, 31 pediatrics, 32 and circadian 33 ), and on October 30, 2023, via a global review of the epidemiology and clinical spectrum of cluster headache 34 . We chose not to perform a systematic review because, based on our prior experiences, 31–33 cluster headache features are sometimes mentioned only in the results section and thus are not easily identified with searches of titles and abstracts.…”

Galcanezumab Add-on in Refractory Cluster Headache

“…Cluster headache (CH) is one of the most serious pain conditions in medicine today, affecting nearly 0.1% of the general population and presenting with recurrent, exclusively unilateral, and severe periorbital headache attacks lasting 30-180 minutes and accompanied by restlessness, agitation, and ipsilateral autonomic features. (1,2) Typically, CH attacks occur in clusters or bouts with unpredictable cyclical periodicity followed by headache-free periods. There are two subforms of CH, the episodic CH (eCH) and the chronic CH (cCH).…”

Hyperalgesia, Increased Temporal Summation and Impaired Inhibitory Mechanisms in Episodic and Chronic Cluster Headache: An Observational Study

“…According to the 3rd edition of the International Criteria of Headache Disorders (ICHD-III), Cluster Headache (CH) is the most common type of trigeminal-autonomic headache [1]. It affects 0.1% of the general population [2], causing loss of quality of life and socioeconomic burdens [3,4]. Clinically, it is characterized by excruciating pain in the orbital, supraorbital and temporal areas, and it often coexists with autonomic symptoms that usually occur ipsilaterally to the pain, such as lacrimation, conjunctival injection, rhinorrhoea and hyperhidrosis [5].…”