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Sex-specific clinical differences in cluster headache: A systematic review and meta-analysis
Ozan Dörtkol1, Esme Ekizoğlu2, Özgün Yetkin3
1Istanbul Physical Therapy and Rehabilitation Education and Research Hospital, Istanbul, Turkey.
Clinical Neurology and Neurosurgery
|June 22, 2026
Summary
Cluster headache (CH) shows similar clinical features between sexes. Females experienced more eyelid edema, migraine, and psychiatric issues, while being less likely to smoke or drink alcohol.
Area of Science:
- Neurology
- Headache Medicine
- Epidemiology
Background:
- Sex-related differences in cluster headache (CH) presentation are inconsistently reported.
- Understanding these differences is crucial for accurate diagnosis and management.
Purpose of the Study:
- To systematically review and meta-analyze sex differences in CH clinical features.
- To investigate variations in attack characteristics, autonomic symptoms, associated features, and comorbidities between sexes.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Searched PubMed, Embase, Scopus, and Web of Science for observational studies up to July 2025.
- Included 19 high-quality studies (Newcastle-Ottawa Scale score ≥7) for quantitative analysis using random-effects models.
Main Results:
- No significant sex differences in age-at-onset, attack duration/frequency, pain intensity, or rhythmicity.
- Eyelid edema was more common in females (OR=1.94).
- Females had higher rates of migraine (OR=2.72) and psychiatric comorbidities (OR=1.73), and lower rates of smoking (OR=0.33) and alcohol consumption (OR=0.32).
Conclusions:
- Cluster headache exhibits a largely similar clinical phenotype across sexes.
- Observed differences in comorbidities, lifestyle, and eyelid edema may stem from multifactorial influences.
- Mechanistic conclusions are limited due to the observational nature of the included studies.
