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More precise phenotyping of cluster headache using prospective attack reports.

A H Snoer1, N Lund1, R H Jensen1

  • 1Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Copenhagen, Denmark.

European Journal of Neurology
|May 7, 2019
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Summary

Retrospective cluster headache (CH) attack descriptions overestimate duration and severity compared to prospective reports. While CH attacks show low within-patient variability, presentation differs between patients, particularly in women.

Keywords:
accompanying symptomsall headachecluster headachediarymigrainous symptoms

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Area of Science:

  • Neurology
  • Headache Medicine
  • Clinical Neuroscience

Background:

  • Clinical characteristics of cluster headache (CH) are often based on retrospective patient recall.
  • The reliability of retrospective descriptions for CH attacks is uncertain.
  • Understanding attack variability is crucial for accurate diagnosis and management.

Purpose of the Study:

  • To compare retrospective and prospective descriptions of cluster headache attacks.
  • To assess the within- and between-patient variability of CH attacks.
  • To identify potential biases in retrospective reporting of CH symptoms.

Main Methods:

  • Fifty-seven CH patients provided retrospective attack descriptions via semi-structured interviews.
  • Patients prospectively recorded up to 10 CH attacks in a headache diary.
  • Key characteristics analyzed included attack severity, duration, and the presence of autonomic and migrainous symptoms.

Main Results:

  • Retrospective reports significantly overestimated untreated attack duration and severity compared to prospective diary entries.
  • A higher number of autonomic symptoms were reported retrospectively versus prospectively.
  • Within-patient variability for attack characteristics was low, but significant differences existed between patients, with women reporting more severe and longer attacks.

Conclusions:

  • Significant discrepancies exist between retrospective and prospective CH attack descriptions, particularly regarding duration and severity.
  • Cluster headache attacks exhibit low intra-patient consistency but high inter-patient variability.
  • Increased awareness of CH symptoms, especially in women who may be misdiagnosed with migraine, is warranted due to symptom overlap.