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Four decades of experience with cluster headache: description of a series from a tertiary hospital
Jorge Madera1, S Pérez Pereda1, V González Quintanilla1
1Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria-IDIVAL, Santander, Spain.
Insights
Cluster headache (CH) is often misdiagnosed, with a significant delay in diagnosis. This study highlights the characteristics of CH patients, including a high prevalence of unhealthy lifestyle habits and the frequent occurrence of episodic CH.
Area of Science:
- Neurology
- Epidemiology
Background:
- Cluster headache (CH) is a rare neurological disorder with limited epidemiological data in many regions.
- This study addresses the lack of comprehensive CH series in the country by providing longitudinal data.
Purpose of the Study:
- To longitudinally describe the clinical characteristics of patients diagnosed with cluster headache (CH).
- To analyze the prevalence, phenotypes, and diagnostic delay associated with CH.
Main Methods:
- Retrospective analysis of clinical charts of patients diagnosed with CH.
- Inclusion of 153 patients diagnosed with CH, with data collected since 1980.
Main Results:
- The study identified 153 CH patients, predominantly male (89.5%), with a mean age at diagnosis of 39.5 years.
- Episodic CH (eCH) was more common (92.2% males) than chronic CH (cCH; 76% males), with a later onset in cCH.
- A significant diagnostic delay of approximately 7 years was observed, with a high proportion of patients exhibiting unhealthy lifestyle habits at diagnosis.
Conclusions:
- The minimal prevalence of CH is estimated at 0.05%, with eCH being the most frequent phenotype.
- A benign course with a single cluster period occurs in over 10% of patients.
- Diagnostic delay underscores insufficient recognition of CH; late onset and female gender are associated with cCH.
Introduction:
There are practically no series of cluster headache (CH) in our country. Our aim was to longitudinally describe the characteristics of patients with CH seen in our Hospital since 1980.
Methods:
Retrospective analysis of the clinical charts of patients diagnosed as CH.
Results:
We included 153 patients diagnosed as CH. 137 (89,5%) males, with a mean age (MA) at diagnosis of 39.5 years (mean deviation 11.4) and a MA at the beginning of the symptoms of 32.8 years (mean deviation 11.3). 128 suffered from episodic CH (eCH; 92.2% males) and 25 chronic CH (cCH; 76% males). The MA at the beginning was delayed in cCH as compared with eCH (37.6 versus 31.8; p = 0.023). Four patients (2.6%) had familial antecedents. Only 3 (2%) referred visual aura. At diagnosis, 66% were smokers and 15% heavy alcohol drinkers. The median duration of cluster period was 60 days, with a median frequency of every 2 years. 16 cases (10.5%) presented a benign course with only one cluster period.
Conclusions:
The minimal prevalence of CH in our area was 0.05%, with eCH being the most frequent phenotype. Up to one out of 10 patients showed a benign form with just one cluster period. The diagnostic delay close to 7 years indicates an insufficient recognition of this entity. A high proportion of CH patients showed, already at diagnosis, unhealthy life habits. Cluster periods lasted an average of 2 months and occurred approximately every 2 years. A late beginning and being a woman were associated with the variant of cCH.
