title: Diagnostic and therapeutic errors in cluster headache: a hospital-based study.
abstract: BACKGROUND
  Cluster headache (CH) is a severe, disabling form of headache. Even though CH has a typical clinical picture it seems that its diagnosis is often missed or delayed in clinical practice. CH patients may thus face: misdiagnosis, unnecessary investigations and delays in accessing adequate treatment. This study was conducted to investigate the occurrence of diagnostic and therapeutic errors with a view to improving the clinical and instrumental work-up in affected patients.
  
  
  METHODS
  Our study comprised 144 episodic CH patients: 116 from Italy and 28 from Eastern European countries (Moldova, Ukraine, Bulgaria). One hundred six patients (73.6%) were examined personally and 38 (26.4%) were evaluated through telephone interviews conducted by headache specialists using an ad hoc questionnaire developed by the authors.
  
  
  RESULTS
  The sample was predominantly male (M:F ratio 2.79:1) and had a mean age of 42.4 ± 9.8 years; approximately 76% of the patients had already consulted a physician about their CH at the onset of the disease. The mean interval between onset of the disease and first consultation at a headache center was 4.1 ± 5.6 years. The patients had consulted different specialists prior to receiving their CH diagnosis: neurologists (49%), primary care physicians (35%), ENT specialists (10%), dentists (3%), etc. Misdiagnoses at first consultation were recorded in 77% of the cases: trigeminal neuralgia (22%), migraine without aura (19%), sinusitis (15%), etc. The average "diagnostic delay" was 5.3 ± 6.4 years and the condition was diagnosed approximately ("doctor delay": one year). Instrumental and laboratory investigations were carried out in 93% of the patients prior to diagnosis of CH. Some of the patients had never received abortive or preventive medications, either before or after diagnosis. Medical prescription compliance: 88% of the cases.
  
  
  CONCLUSIONS
  Our results emphasize the need to improve specialist education in this field in order to improve recognition of the clinical picture of CH and increase knowledge of the proper medical treatments for de novo CH. Continuous medical education on CH should target general neurologists, primary care physicians, ENT specialists and dentists. A study on a larger population of CH patients may further improve error-avoidance strategies.
authors.forename: Cristina
authors.initials: C
authors.lastname: Voiticovschi-Iosob
authors.forename: Marta
authors.initials: M
authors.lastname: Allena
authors.forename: Ilaria
authors.initials: I
authors.lastname: De Cillis
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nappi
authors.forename: Ottar
authors.initials: O
authors.lastname: Sjaastad
authors.affiliation: Pavia Headache Center, C, Mondino National Neurological Institute, University of Pavia, Pavia, Italy. fabio.antonaci@unipv.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Antonaci
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D003027:Cluster Headache / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D005061:Europe, Eastern; D005260:Female; D006761:Hospitals; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis*; D010820:Physicians; D058007:Physicians, Primary Care; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014277:Trigeminal Neuralgia / Q000175:diagnosis*
chemical_list: D000700:Analgesics