Cluster Headache With Accompanying Migraine-Like Features: A Possible Clinical Phenotype

There are limited literature data on migraine-like accompanying features (MLF) in patients with cluster headache (CH). These symptoms are frequently reported by patients and may delay CH diagnosis.

The aim of the present study was to investigate the occurrence of migraine-like symptoms in an Italian case series of CH patients and to determine whether these features influence the clinical phenotype of CH.

A cross-sectional study was performed in all consecutive patients referred to the Parma Headache Centre between 1975 and 2013 affected by CH; the cases were subsequently reviewed applying the ICHD3-beta criteria. Our initial study sample consisted of 785 subjects, 569 men (72.5%) and 216 women (27.5%). We then identified those patients who reported at least one of the migraine accompanying symptoms (ie, nausea or vomiting or photophobia and phonophobia).

We found 362 patients (46%) with MLF, 250 men (43.9% of the initial male sample) and 112 women (51.9% of the initial female sample), and 423 patients (54%) without MLF, 319 men (56.1% of the initial male sample) and 104 women (48.1% of the initial female sample). Multiple logistic regression analysis highlighted some demographic and clinical features that significantly characterized patients with MLF after adjusting for confounding: they were more frequently female (OR 1.78, CI 1.11-2.80), with a relatively younger age of onset (OR 1.82, CI 1.06-2.91) than expected, attacks were longer in duration (OR 1.85, CI 1.04-2.46) and accompanied by a more frequent ptosis (OR 1.67, CI 1.04-2.34), sweating (OR 1.63, CI 1.02-2.21), and miosis (OR 1.54, CI 1.12-1.93); osmophobia was also more frequently reported (OR 1.76, CI 1.28-2.46).

Our study confirms the high proportion of CH patients with MLF, which is reported in literature. The presence of MLF seems to relate to some peculiar demographic and clinical characteristics of CH sufferers. Whether these features influence the response to therapy remains to be determined.