Impairment in episodic and chronic cluster headache

Abstract

Despite being an excruciating headache, little is known about the burden of cluster headache (CH) regarding its various subtypes. In a multicentre, prospective study, patients with chronic CH (n = 27), with episodic CH in the active (n = 26) and outside the active period (n = 22), migraine patients (n = 24) and healthy controls (n = 31) were included. Epidemiological data, the German version of the Headache Disability Inventory (HDI) and a screening for psychiatric complaints were applied. About 25% of chronic CH patients in our study received invalidity allowance due to CH. HDI scores (total and subscales emotion and function) indicated a severe headache-specific disability (one-way ANOVA: P< 0.01). Patients with chronic and active episodic CH were significantly more affected than patients with inactive CH and migraine. Healthy volunteers were significantly less affected than all headache patients. Symptoms suggestive of psychiatric co-morbidity were found predominantly in chronic CH: depressive symptoms (56%), signs of agoraphobia (33%) and suicidal tendencies (25%) were frequently reported. Patients with chronic and active episodic CH were severely impaired in non-economic and economic domains such as disability, working life and psychiatric complaints. Remarkably, psychiatric co-morbidity was highest in chronic CH. Thus, especially chronic CH warrants special medical and further supportive care.

Cluster headache and neuropsychological functioning

“…Patients in the ECH groups were allocated to one subgroup only and not examined twice (independent samples). Detailed data on the sample can be found elsewhere (4). All participants filled in the German version of the 'Alcohol Use Disorders Identification Test' (AUDIT) (30), a screening questionnaire to identify harmful drinking.…”

Recommandations pour le diagnostic et le traitement de l’algie vasculaire de la face

“…Dans une étude nord-américaine, 55 % des sujets souffrant d'AVF alléguaient avoir eu des idées suicidaires (grade B) [8]. Une étude prospective, multicentrique, ayant concerné un faible effectif de patients a montré que les symptômes dépressifs concernaient principalement la forme chronique de l'AVF (grade B) [18]. Les données disponibles ne permettent pas de trancher entre une authentique comorbidité et un retentissement émotionnel de la maladie.…”

“…Ces données sont à rapprocher de l'importante altération de la qualité de vie mise en évidence au travers de l'échelle SF-36 chez 56 patients souffrant d'AVF et suivis en centre tertiaire (grade C) [20]. Les patients souffrant d'AVF chronique et d'AVF épisodique en période active ont une perte de productivité plus importante que les patients souffrant d'AVF en dehors des périodes douloureuses et que les migraineux (grade C) [18]. Dans une étude mono-centrique de 179 patients suivis dans un centre tertiaire allemand, les coûts directs moyens sur 6 mois ont été estimés à 5963 D et sont apparus corrélés positivement à la fréquence des crises (grade C) [21].…”

Stimulation of the sphenopalatine ganglion in intractable cluster headache: Expert consensus on patient selection and standards of care

“…It causes significant medical but also economical (2) and social impairment (3,4). Although most patients respond to acute (triptans, oxygen and lidocaine) and preventative medication (verapamil, lithium, topiramate, methysergide and cortisone), a small proportion of patients are drug refractory or intolerant to established preventive drugs.…”