Interictal Burden of Cluster Headache

Abstract

Objective.-The aim of this study was to measure the interictal burden (IIB) associated with cluster headache (CH).Background.-CH is characterized by an alternation of excruciatingly painful attacks and pain-free periods. Absence of pain does not necessarily imply absence of symptoms, though. Some may persist or improve more slowly than pain; others may arise in between attacks.Methods.-Participants filled out an online survey based on the EUROLIGHT questionnaire. Inclusion criteria were a reported diagnosis of CH and residency in a European country; exclusion criteria were refusal to give informed consent and to complete the questionnaire.Results.-Most of the burden was related to higher headache frequencies: ongoing symptoms despite pain freedom, impaired autonomy due to avoidance of triggers, reluctance to tell others about the disease, and the feeling of not being understood by family and friends, employers and colleagues. Irreversible, potentially accumulating burden may occur if headache frequency is high; examples are impairment of career options, relationships, and family planning issues. Worrying about future attacks and avoiding potential triggers occur independently from attack frequency and disease duration. There were no differences between the in-bout and the out-bout period among participants with episodic CH. Participants with chronic CH reported greater IIB.Conclusions.-Even between attacks CH can have a huge and potentially irreversible impact on life. Different types of IIB were identified, all of which may contribute to the total burden of disease. As cumulative burden might be irreversible, prevention strategies need to be developed.Key words: cluster headache, interictal burden, cumulative burden, self-concealment, fear-avoidance model Abbreviations: CH cluster headache, CI confidence interval, IIB interictal burden, n.r. not reported, OR odds ratio, SD standard deviation (Headache 2020;60:360-369) Headache

Occipital Nerve Stimulation for Pain Modulation in Drug-Resistant Chronic Cluster Headache

“…Considering that these patients are refractory to all therapies and suffer from high levels of disability and impact [23], a threshold of a > 30% decrease in the frequency of attacks is usually considered sufficient to define response according to different studies [24]. In our cohort, at the end of follow-up, and taking the 18 of the 22 patients who were implanted with a definitive ONS into account, 61.1% (11/18) of the patients presented a perceived improvement of more than 30%.…”

Meta‐analysis of melatonin levels in cluster headache—Review of clinical implications

“…4,5 Despite its low prevalence compared with migraine and tension-type headache, 6 CH is a debilitating primary headache disorder with substantial personal and healthcare impact that requires effective treatment and prevention. 7,8 Preventive medications (verapamil and lithium are considered the primary options) present a number of contraindications and adverse events that may impede their use, while many cases prove refractory to the initial approach and require the administration of additional medications, warranting the investigation for additional candidates to enhance our armamentarium in the management of CH. 9 Exogenous melatonin (MT) constitutes a relatively safe treatment option 10,11 that has provided encouraging results in the prevention of PHDs including individuals with CH.…”

“…16,17 Therefore, a more complex relationship may exist between CH and sleep homeostasis. Records excluded after assessment of Title/Abstract -not relevant (291) -other study designs (138) -not in English (2) -patent (1) -animal studies (2) -letters to the editor, editorials, commentaries, (14) -study protocols (10) -book chapters (8) n = 466…”

The impact of the disease burden on the quality of life of cluster headache patients

“…For instance, in the interictal period, many are frightened of future attacks, unable to work, or disappointed by other's lack of understanding. 2 Nevertheless, therapeutic guidelines focus solely on aborting and preventing headache spells. [3][4][5][6] Attacks are a sine qua non of the disorder, 7 and treating them is crucial.…”

“…We refer to stresses and strains associated with the disease and present in the absence of a headache attack as interictal burden. 2 This study investigates whether potentially modifiable aspects of the in-bout interictal burden-i.e. the interictal burden present during the in-bout period-independently influence the QoL of CH patients.…”