Neurology 2002;58:354-361
Cluster headache - A prospective clinical study with
diagnostic implications
From the Headache Group, Institute of Neurology, Queen Square,
London, United Kingdom.
Background: Cluster headache, when compared with
migraine or tension-type headache, is an uncommon form of primary
neurovascular headache. However, with a prevalence of approximately
0.1% and a lengthy history of disabling and distressing episodic
pain, cluster headache is an important neurologic problem.
Methods: Patients (n = 230) were recruited from
our specialist clinic (24%) or from support groups (76%). All
patients had a detailed history taken by at least two physicians and
were assigned diagnoses according to the International Headache
Society Diagnostic Guidelines.
Results: The pain characteristics were of a
strictly unilateral, predominantly retro-orbital (92%) and temporal
pain (70%). Of the cranial autonomic features, lacrimation (91%) was
the most common. Nausea (50%), photophobia (56%), and phonophobia
(43%) often were noted, as was a sense of agitation or restlessness
in 93% of patients. Typical migrainous aura was noted in 14% of
this cohort. Most patients (79%) had episodic cluster headache, which
was largely the same clinically as chronic cluster headache except
for the persistence of attacks over time. The overall male-to-female
ratio in this sample was 2.5:1, and this has decreased with time.
Neither oral contraceptive use, menses, menopause, nor hormone
replacement therapy had any consistent effect on cluster headache in
women. Less than half of the patients had tried injectable
sumatriptan, and many had not tried high-flow oxygen. Several
unproven preventative agents that usually are used in migraine and an
array of alternative therapies had been used; none of the latter was
consistently effective.
Conclusion: Patients with cluster headache offer
a population of primary headache patients with devastating acute
attacks of pain. The syndrome is stereotyped with effective
evidence-based treatments that are prescribed in only half of
patients having cluster headache.
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