Background
Methods
Results
Area distribution of patients
Study population
Patient characteristics | Total N = 120 | Males n = 105 | Females n = 15 | P-value |
---|---|---|---|---|
Type of cluster headache | ||||
Episodic | 111 | 97 | 14 | 1.00 |
Chronic | 9 | 8 | 1 | |
Age in years (mean ± SD) | 34.9 ± 10.5 | 34.7 ±10.6 | 36.5 ± 9.7 | |
Age at onset in years (mean ± SD) | 26.7 ± 10.9 | 26.6 ± 10.8 | 28.0 ± 11.4 | 0.652 |
Pain intensity (VAS) | 8.9 ± 1.4 | 8.9 ± 1.4 | 8.6 ± 1.6 | 0.454 |
Family history of Cluster headache | 8 | |||
Mother | 2 | |||
Father | 4 | |||
Others | 2 |
History of smoking and drinking
Sites and laterality of headache
Total (N = 120) | Males (n = 105) | Females (n = 15) | P-value | |
---|---|---|---|---|
Sites of pain
| ||||
Temporal | 90 (75.0) | 78 (74.3) | 12 (80.0) | 0.759 |
Retro-orbital | 82 (68.3) | 71 (67.6) | 11 (73.3) | 0.773 |
Forehead | 39 (32.5) | 36 (34.3) | 3 (20.0) | 0.381 |
Vertex | 39 (32.5) | 32 (30.5) | 7 (46.7) | 0.244 |
Occipital | 27 (22.5) | 24 (22.9) | 3 (20.0) | 1.00 |
Neck | 5 (4.2) | 5 (4.8) | 0 | 1.00 |
Teeth | 5 (4.2) | 5 (4.8) | 0 | 1.00 |
Ear | 5 (4.2) | 5 (4.8) | 0 | 1.00 |
Cheek | 3 (2.5) | 3 (2.9) | 0 | 1.00 |
Nose | 2 (1.7) | 2 (1.9) | 0 | 1.00 |
Laterality of pain
| ||||
Right-side only | 62 (51.7) | 55 (52.4) | 7 (46.7) | 0.785 |
Left-side only | 43 (35.8) | 40 (38.1) | 3 (20.0) | 0.251 |
Predominant right-side | 5 (4.2) | 4 (3.8) | 1 (6.7) | 0.493 |
Predominant left-side | 4 (3.3) | 2 (1.9) | 2 (13.3) | 0.076 |
Changing sides | 6 (5.0) | 4 (3.8) | 2 (13.3) | 0.163 |
Cranial autonomic and additional features in patients with CH
Total (N = 120) | Males (N = 105) | Females (N = 15) | P-value | |
---|---|---|---|---|
Autonomic features
| ||||
Lacrimation | 87(72.5)※ | 77(73.3) | 10(66.7) | 0.553 |
Conjunctival injection | 76(63.3) | 67(63.8) | 9(60.0) | 0.781 |
Rhinorrhea | 40(33.3)※ | 38(36.2) | 2(13.3) | 0.140 |
Nasal congestion | 39(32.5) | 37(35.2) | 2(13.3) | 0.139 |
Ptosis/miosis | 20(16.7) | 17(16.2) | 3(20.0) | 0.714 |
Facial sweating | 22(18.3)# | 20(19.0) | 2(13.3) | 0.736 |
Blepharoedema | 28(23.3) | 23(21.9) | 5(33.3) | 0.338 |
Additional features
| ||||
Nausea | 72(60.0) | 64(61.0) | 8(53.3) | 0.585 |
Vomiting | 40(33.3) | 36(34.3) | 4(26.7) | 0.771 |
Photophobia | 50(41.7) | 43(41.0) | 7(46.7) | 0.782 |
Phonophobia | 49(40.8) | 42(40.0) | 7(46.7) | 0.780 |
Sense of restlessness and agitation | 46(38.3) | 40(33.3) | 6(40.0) | 1.00 |
Aggravation by physical activities | 55(45.8) | 46(43.8) | 9(60.0) | 0.277 |
Aura
| 0 | 0 | 0 |
Periodicity of CH
Total (N = 120) | Males (n = 105) | Females (n = 15) | |
---|---|---|---|
Frequency of clusters
| |||
More than 2 times/yr | 9 (7.5) | 7 (6.7) | 2 (13.3) |
1-2 times/yr | 43 (35.8) | 36 (34.3) | 7 (46.7) |
Less than 1 time/yr | 46 (38.3) | 42 (40.0) | 4 (26.7) |
First experience of cluster | 14 (11.7) | 13 (12.4) | 1 (6.7) |
Irregular | 8 (6.7) | 7 (6.7) | 1 (6.7) |
Duration of clusters
| |||
Less than 2 weeks | 17 (14.2) | 14 (13.3) | 3 (20.0) |
From 2 weeks to less than 1 month | 34 (28.3) | 27 (25.7) | 7 (46.7) |
From 1 to 2 months | 39 (32.5) | 36 (34.3) | 3 (20.0) |
More than 2 months | 8 (6.7) | 8 (7.6) | 0 |
First experience of cluster | 14 (11.7) | 13 (12.4) | 1 (6.7) |
Irregular | 8 (6.7) | 7 (6.7) | 1 (6.7) |
Frequency of onset of attacks
| |||
More than 2 times/day | 16 (13.3) | 12 (11.4) | 4 (26.7) |
1 to 2 times/day | 88 (73.3) | 81 (77.1) | 7 (46.7) |
Less than 1 time/day | 16 (13.3) | 12 (11.4) | 4 (26.7) |
Duration of onset of attacks
| |||
Less than 1 h | 21 (17.5) | 18 (17.1) | 3 (20.0) |
From 1 h to less than 2 h | 47 (39.2) | 42 (40.0) | 5 (33.3) |
From 2 h to 3 h | 41 (34.2) | 36 (34.3) | 5 (33.3) |
More than 3 h | 11 (9.2) | 9 (8.6) | 2 (13.3) |
Possible trigger factors
Quality of life for CH patients
Cluster headache (N = 120) | Migraine (N = 464)
[16] | |
---|---|---|
Life quality | 2.38 (0.81) | 3.22 (0.67) |
Health level | 2.08 (0.84) | 2.98 (0.83) |
Daily life ability | 2.68 (0.65) | 3.35 (0.78) |
Satisfied with yourself | 2.57 (0.64) | 3.45 (0.80) |
Interpersonal relationship | 2.85 (0.58) | 3.76 (0.68) |
Habitation condition | 2.73 (0.58) | 3.34 (0.84) |
Daily life energy | 2.09 (0.77) | 3.03 (0.72) |
Payment ability | 2.10 (0.60) | 2.60 (0.66) |
Time delay for correct diagnosis
Time delay to diagnosis | N (%) |
---|---|
Less than 1 year | 13 (10.8) |
1 year | 2 (1.7) |
2 years | 10 (8.3) |
3 years | 10 (8.3) |
4 years | 10 (8.3) |
5 years | 10 (8.3) |
6 years | 6 (5.0) |
7 years | 4 (3.3) |
8 years | 5 (4.2) |
9 years | 2 (1.7) |
10 years | 17 (14.2) |
More than 10 years | 31 (25.8) |
Discussion
UK
[5] 2002 | Germany
[6] 2006 | Germany
[7] 2012 | Italy
[9]2005 | USA
[13] 2012 | Japan
[15] 2011 | Taiwan
[14] 2004 | Mainland China | |
---|---|---|---|---|---|---|---|---|
M:F Ratio
| 2.5:1 | 3.5:1 | 3.4 :1 | 1.3:1 | 2.6:1 | 3.8: 1 | 6.4: 1 | 7:1 |
CCH (%)
| 21% | 16.7% | 31.1% | 19% | -- | 3.5% | 0 | 7.5% |
Mean age at onset (yrs)
| 28.4 (ECH) 37 (CCH) | -- | 31.6 | 35.7 | 21-30※
| 31.0 | 26.9 | 26.7 |
Family history of CH
| 5% | -- | -- | -- | 18% | -- | 5.8% | 6.7% |
Common sites of pain
| Retro-orbital, temporal, upper teeth | -- | Peri-orbital, occipital, orofacial | -- | Retro-orbital, upper teeth, jaw | Retro-orbital, temporal, occipital | Temporal, retro-orbital, occipital | Temporal, retro-orbital, forehead |
Predominant laterality
| Right | -- | -- | -- | Right | Right | Right | Right |
Most cranial autonomic features
| Lacrimation (91%) | -- | Conjunctival injection and/or lacrimation | -- | Lacrimation (91%) | Lacrimation (66.3%) | Lacrimation (83%) | Lacrimation (72.5%) |
Most additional features
| Photophobia (56%) | Photophobia/Phonophobia (61.2%) | Photophobia/Phonophobia (73.2%) | -- | Photophobia (48%) | Nausea (39.5%) | Phonophobia (58%) | Nausea (60.0)% |
Sense of agitation or restlessness
| 93% | 67.9% | 83% | -- | 99.2% | 69.8% | 51% | 38.3% |
Aura
| 14% | 23% | -- | -- | 21% | -- | 1% | 0 |
Most common duration of attacks
| 72-159 min | 45-180 min (67.9%) | 98 ± 75 | -- | -- | From 1 h to less than 2 h (46.5%) | From 1 h to less than 2 h (34%) | From 1 h to less than 2 h (39.2%) |
Most common attack time
| Nocturnally (73%) | -- | Nocturnally | -- | Between 12 am and 3 am | Nocturnally(47.7%) | Midnight (28%), afternoon (27%) | Between 7 am and 10 am, 2 pm and 4 pm |
Seasonal propensity
| Spring and Autumn | -- | Spring | -- | Oct., Sep., Apr., Mar. and Nov. | -- | Dec., Mar. | Spring |