Pre-attack signs and symptoms in cluster headache: Characteristics and time profile

Abstract

Introduction In contrast to the premonitory phase of migraine, little is known about the pre-attack (prodromal) phase of a cluster headache. We aimed to describe the nature, prevalence, and duration of pre-attack symptoms in cluster headache. Methods Eighty patients with episodic cluster headache or chronic cluster headache, according to ICHD-3 beta criteria, were invited to participate. In this observational study, patients underwent a semi-structured interview where they were asked about the presence of 31 symptoms/signs in relation to a typical cluster headache attack. Symptoms included previously reported cluster headache pre-attack symptoms, premonitory migraine symptoms and accompanying symptoms of migraine and cluster headache. Results Pre-attack symptoms were reported by 83.3% of patients, with an average of 4.25 (SD 3.9) per patient. Local and painful symptoms, occurring with a median of 10 minutes before attack, were reported by 70%. Local and painless symptoms and signs, occurring with a median of 10 minutes before attack, were reported by 43.8% and general symptoms, occurring with a median of 20 minutes before attack, were reported by 62.5% of patients. Apart from a dull/aching sensation in the attack area being significantly ( p < 0.05) more frequent among men and episodic patients, compared with women and chronic patients respectively, no other differences in the prevalence of pre-attack symptoms were identified between groups. Conclusion Pre-attack symptoms are frequent in cluster headache. Since the origin of cluster headache attacks is still unresolved, studies of pre-attack symptoms could contribute to the understanding of cluster headache pathophysiology. Furthermore, identification and recognition of pre-attack symptoms could potentially allow earlier abortive treatment.

More precise phenotyping of cluster headache using prospective attack reports

“…In retrospective studies of CH attacks patients have been requested to describe their ‘typical attacks’ , which may be interpreted very differently from patient to patient. The duration and severity of attacks is decreased in response to treatment and some clinical studies distinguish between treated and untreated attacks . The same, however, is not usually specified for other associated symptoms, potentially distorting the image of a typical CH attack.…”

“…The diagnosis was confirmed, and clinical and demographical data were recorded at a semi‐structured interview. The retrospective attack descriptions were documented at inclusion based on a 33‐symptom questionnaire constructed for the purpose of the study . At the inclusion visit patients were carefully instructed in how to fill out the questionnaires.…”

Exploring the Connection Between Sleep and Cluster Headache: A Narrative Review

“…In a study of cluster headache patients, the prodromal phase was studied in 80 patients with episodic and chronic cluster headache. In 83.3% of patients, prodromal symptoms occurred, warning the patient of an impending attack [81]. Although cluster headaches do not have aura as do some migraine headaches, prodromal warning symptoms for cluster headache appear worthy of greater study.…”

Hypothalamic regulation of headache and migraine

“…One could subdivide primary headache syndromes into those where the clinical picture points towards hypothalamic involvement (migraine, trigemino-autonomic headaches (TAC) and those where the clinical picture does not (tension type headache and most group 4 headaches (with the exception of hypnic headache) following the IHS classification (3)). The headache type where hypothalamic involvement is clinically rather obvious is cluster headache (4), which can be considered to exist on a continuum with the symptoms of other TACs including hemicrania continua, paroxysmal hemicrania, and the short-lasting unilateral neuralgiform headaches including short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). Each of the TACs manifests with unilateral headaches associated with ipsilateral cranial autonomic features and can be differentiated by the duration and frequency of attacks and therapeutic response to indomethacin.…”