Late-onset cluster headache: some considerations about 73 cases

Data in the literature on cluster headache (CH) indicate a mean age at onset of about 29-30 years; recently, however, cases have been reported with onset in old age. A review of age at onset in all CH patients (n = 693) followed at the University of Parma Headache Centre between 1976 and 2011 shows that 73 (10.5 %) patients began to suffer from CH after age 50. In these 73 patient, the gender (M:F) ratio was 1.4:1, while in the 620 patients with CH onset before age 50, it was 2.5:1. In the patients with CH onset after and before age 50, respectively, the distribution by CH subtype shows that the episodic-to-chronic ratio was 7.6:1 and 7.9:1 in men and 1.5:1 and 7.8:1 in women. In episodic CH men with onset after 50 the average duration of active periods was 60 versus 39 days for those with onset before 50. In women, the duration was 80 and 42 days, respectively. In conclusion, our case review suggests that CH onset after age 50 is not rare, especially in women. Additionally, late onset represents a negative prognostic factor because, particularly in women, CH will more likely be a chronic form and even in episodic forms active periods will last longer.