Possible Predictive Factors in the Evolution of Episodic to Chronic Cluster Headache

Abstract

The purpose of our study was to identify general factors and distinctive clinical features differentiating patients with chronic cluster headache (CH) evolved from episodic CH and patients with episodic CH. Our study sample included 28 patients suffering from chronic CH evolved from episodic CH and 258 patients with episodic CH; all were referred to the Headache Center of Parma between December 1975 and June 1998. Patients with episodic CH were selected from all episodic CH referrals (n = 485) and selection was based on the duration of the disorder, which was to exceed the average period needed for an episodic form to turn into a chronic form (4.5 years for females and 7.0 years for males). At CH onset, the mean age for patients with chronic CH evolved from episodic CH was older than for those with episodic CH. Among patients with chronic CH, more were smokers or heavy drinkers, and had suffered a head injury. Clinically, episodic CH evolving into chronic CH was characterized by a high frequency of cluster periods, a larger proportion of patients with attacks not occurring strictly within cluster periods, and remission periods lasting less than 6 months. Possible predictive factors in the development of chronic CH appear to be CH onset from the third decade of life onward, the occurrence of more than one cluster period a year, and the short-lived duration of remission periods. The role played by head injury and cigarette smoking in the evolution of the disorder still cannot be established with certainty.

Impact of continuing or quitting smoking on episodic cluster headache: a pilot survey

“…The results of our investigation are similar to those in literature [6,11,13,14,27,38,39] with regard to the prevalence of males and smokers, the long duration of the disorder, and the data indicating that the majority of patients (over 90%) began to smoke before the beginning of CH. In Italy there has been a decline of smoking prevalence for both sexes since 1990 [40].…”

“…This high prevalence of smokers, greater than in the general population [7], supports the possibility that smoking may trigger the development of CH [10-12]. In favour of a causal relationship between smoking and CH, it has been observed that in most cases the onset of the smoking habitus precedes the beginning of CH [6,8,13-15] and that the prolonged exposure to second hand smoke during childhood may trigger CH even in non-smokers [12,16]. Moreover, CH develops earlier in people living with smoking parents [12].…”

Clinical profile of cluster headaches in China – a clinic-based study

“…Most clinical characteristics of CH reported in this study are consistent with other studies from Western and Eastern regions in the world, which included gender dominance for male [4-15,17-22], similar age at onset [5-7,9,13-15,18,19], temporal or retro-orbital regions as common sites of pain [5,7,13-15], lacrimation as the most frequent autonomic feature [5,7,13-15], high frequencies of migrainous features, low frequency of positive family history and seasonal propensity in spring and autumn (Table 7). Yet, it is also worth noting some discrepancies between the current and previous results.…”

Topiramate in prevention of cluster headache in the Taiwanese

“…Chronic cluster headache accounts for 10-21% of all cluster headaches, [3,10,11] but is rare in the Taiwanese and Asians, [12] with Case 13 in the present series being the fi rst case of chronic cluster headache ever reported in Taiwan. [13] Interestingly, she did not have a good response to topiramate treatment until the dose was reached 400 mg/day.…”