Cluster headache: clinical presentation, lifestyle features, and medical treatment.
BACKGROUND
Cluster headache (CH) is a rare but severe headache form with a distinct clinical presentation. Misdiagnoses and mismanagement among these patients are high.


OBJECTIVE
To characterize clinical features and medical treatment in patients with CH.


METHODS
We established a cohort of 246 clinic-based and non-clinic-based CH patients. The diagnosis of CH was verified according to International Headache Society (IHS) criteria. We used standardized questionnaires to assess associated factors as well as success or failure of treatments.


RESULTS
The majority (75.6%) was not treated before at our clinic-77.6% were males; 74.8% had episodic CH, 16.7% had chronic CH, in the remaining patients, the periodicity was undetermined because they were newly diagnosed. Cranial autonomic features were present in 98.8%, nausea and vomiting in 27.8%, and photophobia or phonophobia in 61.2% of CH patients. Most (67.9%) reported restlessness during attacks and 23% a typical migrainous aura preceding the attacks. The rate of current smoking was high (65.9%). Half of the patients reported that alcohol (red wine in 70%) triggered CH attacks. Eighty-seven percent reported the use of drugs of first choice (triptans 77.6%, oxygen 71.1%) with sumatriptan subcutaneous injection being the most effective drug for acute therapy (81.2%). The most frequently used preventive medications were verapamil (70.3%) and glucocorticoids (57.7%) with equally high effectiveness.


CONCLUSIONS
Apart from the IHS criteria additional features like nausea/vomiting and migrainous aura may guide the diagnosis of CH. A large number of CH patients do not receive adequate treatments.
Schürks
Markus
M
Department of Neurology, University of Duisburg-Essen, Essen, Germany.
Kurth
Tobias
T
de Jesus
Janete
J
Jonjic
Mira
M
Rosskopf
Dieter
D
Diener
Hans-Christoph
HC
D000328:Adult; D000434:Alcoholic Beverages / Q000009:adverse effects; D003027:Cluster Headache / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010100:Oxygen / Q000627:therapeutic use; D011446:Prospective Studies; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use; D012907:Smoking / Q000009:adverse effects; D018170:Sumatriptan / Q000627:therapeutic use; D016896:Treatment Outcome
D017366:Serotonin Receptor Agonists; D018170:Sumatriptan; D010100:Oxygen