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Cluster headache diagnostic delay and its predictors: a systematic review with a meta-analysis
E K Van Obberghen1, R Fabre1,2, M Lanteri-Minet3,4
1Pain Department and FHU InovPain, CHU Nice and Côte d'Azur University, Hôpital Cimiez, 4 rue Reine Victoria, Nice, France.
The Journal of Headache and Pain
|April 9, 2025
Summary
Cluster headache (CH) diagnosis is often delayed, averaging over 10 years. Early recognition of autonomic symptoms may shorten this delay, aiding timely treatment for CH patients.
Area of Science:
- Neurology
- Clinical Neuroscience
- Headache Medicine
Background:
- Cluster headache (CH) presents distinct symptoms but is frequently misdiagnosed.
- Patients experience significant delays in receiving accurate CH diagnosis and appropriate treatment.
Purpose of the Study:
- To systematically review and analyze the diagnostic delay in cluster headache (CH).
- To identify predictors associated with delayed CH diagnosis.
Main Methods:
- A systematic review of PubMed-indexed studies up to December 2024.
- Meta-analysis to estimate mean CH diagnostic delay.
- Qualitative analysis to identify diagnostic delay predictors.
Main Results:
- The overall estimated CH diagnostic delay is 10.43 years.
- Diagnostic delay has decreased since the 1960s, with continued reduction observed since 2000.
- Autonomic symptoms correlated with decreased delay; younger onset, alternating pain, and nocturnal headaches correlated with increased delay.
Conclusions:
- A significant unmet need exists for improved CH diagnosis.
- Further research is required to precisely identify CH diagnostic delay predictors for enhanced patient management.
