Cluster headache in Greece: an observational clinical and demographic study of 302 patients.
BACKGROUND
Cluster headache (CH) is considered the most excruciating primary headache syndrome; although much less prevalent than migraine, it is not rare as it affects more than 1/1000 people. While its clinical presentation is considered stereotypic, atypical features are often encountered. Internationally, cluster headache is often misdiagnosed, undertreated and mistreated.


METHODS
We prospectively studied 302 CH patients, all examined by the same headache specialist. The aim of our study was to describe the demographic and clinical characteristics of CH patients in Greece and draw attention to under-management, under-treatment and mis-treatment often encountered in clinical practice; our purpose is to improve recognition and successful treatment of cluster patients by Greek neurologists and other physicians.


RESULTS
In the present cohort, clinical characteristics of CH are similar to those described in other populations. Beyond the standard clinical characteristics, features like side shifts (12.6 %), location of maximal pain intensity outside the first trigeminal branch division (10.2 %), lack of autonomic features (7 %), presence of associated features of migraine and aggravation by physical activity (10 %) were encountered. Four out of five patients had consulted a physician prior to diagnosis. The median number of physicians seen prior to diagnosis was 3 and the median time to diagnosis was 5 years, though it improved for patients with recent onset. Chronic cluster headache, side shifts, pain location in the face or the back of the head and aggravation by physical activity were found, among others, to be statistically significantly related to delayed diagnosis or more physicians seen prior to diagnosis. Even properly diagnosed patients were often undertreated or mistreated.


CONCLUSIONS
Cluster headache, in a large cohort of Greek patients, has the same phenotypic characteristics as described internationally. Uncommon clinical features do exist and physicians should be aware of those, since they may eventuate in diagnostic problems. Most CH patients in Greece remain misdiagnosed or undiagnosed for rather lengthy periods of time, but time to diagnosis has improved recently. Even after diagnosis, treatment received was suboptimal.
Headache Clinic, Mediterraneo Hospital, Glyfada, Greece. mvikelis@headaches.gr.|Glyfada Headache Clinic, 8 Lazaraki Str, Glyfada, 16675, Greece. mvikelis@headaches.gr.
Michail
M
Vikelis
The David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Alan M
AM
Rapoport
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003027:Cluster Headache / Q000453:epidemiology* / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
Chronic cluster headache; Cluster headache; Cluster headache demographics; Cluster headache phenotype; Delay; Episodic cluster headache; Error; Misdiagnosis; Mismanagement; Mistreatment
Eur J Neurol. 2006 Oct;13(10):1066-77
16987158
J Headache Pain. 2009 Aug;10(4):259-63
19495933
Eur Neurol. 2014;72(3-4):209-12
25227490
Cephalalgia. 2005 Apr;25(4):290-5
15773826
Semin Neurol. 2006 Apr;26(2):242-59
16628535
Cephalalgia. 2016 Jul;36(8):760-4
26481303
Neurology. 2002 Feb 12;58(3):354-61
11839832
J Headache Pain. 2016;17:44
27102121
Nat Rev Neurol. 2016 Oct;12(10):557-8
27615424
Cephalalgia. 2014 Nov;34(13):1079-87
24723673
Cephalalgia. 2003 Apr;23(3):193-6
12662186
J Neurol Neurosurg Psychiatry. 2007 Dec;78(12):1354-8
17442761
Cephalalgia. 2016 May;36(6):547-51
26395893
Dtsch Arztebl Int. 2011 Aug;108(33):543-9
21912573
Cephalalgia. 2008 Jun;28(6):614-8
18422717
J Headache Pain. 2014 Sep 01;15:56
25178541
Lancet. 1998 Jul 25;352(9124):275-8
9690407
Headache. 2006 Sep;46(8):1246-54
16942468
Cephalalgia. 1991 Sep;11(4):169-74
1742772
Curr Neuropharmacol. 2015;13(3):304-23
26411963
J Headache Pain. 2013 Feb 18;14:14
23565739
Headache. 2016 Jul;56(7):1093-106
27432623
Expert Opin Pharmacother. 2015;16(10):1411-5
26027515
Semin Neurol. 2016 Apr;36(2):103-14
27116717
J Headache Pain. 2015;16:59
26113477
Headache. 2012 Jan;52(1):99-113
22077141
Curr Pain Headache Rep. 2007 Apr;11(2):154-7
17367596
Cephalalgia. 1998 Apr;18(3):138-42
9595206
Acta Neurol Scand. 2004 Mar;109(3):175-9
14763953
Ann Neurol. 2004 Oct;56(4):488-94
15455406
Cephalalgia. 2013 Jul;33(9):629-808
23771276
Curr Pain Headache Rep. 2001 Feb;5(1):67-70
11252140
J Headache Pain. 2012 May;13 Suppl 2:S31-70
22581120
Acta Neurol Belg. 2009 Mar;109(1):10-7
19402567