The profile of refractory chronic cluster headache

Area of Science:

• Neurology
• Headache Medicine

Background:

• Chronic cluster headache (CCH) is a rare, challenging primary headache disorder.
• The prevalence and characteristics of refractory CCH (rCCH) are not well-defined.

Purpose of the Study:

• To determine the frequency of rCCH in a CCH population.
• To define the clinical profile and treatments used in refractory patients.

Main Methods:

• Cross-sectional study of 88 CCH patients in Madrid, Spain.
• Data collected on demographics, clinical presentation, and treatment.
• rCCH defined by European Headache Federation criteria; high disease activity defined as >=3 severe attacks/week impacting quality of life despite treatment.

Main Results:

• 68.2% of CCH patients met rCCH criteria.
• rCCH patients had a longer diagnostic delay (4.6 vs. 3.2 years).
• OnabotulinumtoxinA and occipital nerve stimulation (ONS) were used, with significant discontinuation rates; 50% of ONS remained active. 60.2% had high disease activity despite treatment.

Conclusions:

• CCH often has a poor prognosis, with over half meeting refractoriness criteria.
• OnabotulinumtoxinA and ONS may be effective treatments for refractory CCH patients.