The online version of this article (doi:10.1186/1129-2377-15-56) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
CV and FA wrote the manuscript, OS, MA and GN revised the manuscript on the basis of the literature and personal experience in the field. CV and ID interviewed CH patients. All authors read and approved the final manuscript.
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.
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.
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.
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.
Headache Classification Subcommittee of the International Headache Society: The international classification of headache disorders: 2nd edition. Cephalalgia 2004, 24(Suppl 1):9–160.
Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988, 8: 1–93. 10.1046/j.1468-2982.1988.0801001.x CrossRef
Van Alboom E, Louis P, Van Zandijcke M, Crevits L, Vakaet A, Paemeleire K: Diagnostic and therapeutic trajectory of cluster headache patients in Flanders. Acta Neurol Belg 2009, 109(1):10–17. PubMed
Viana M, Tassorelli C, Allena M, Nappi G, Sjaastad O, Antonaci F: Diagnostic and therapeutic errors in trigeminal autonomic cephalalgias and hemicrania continua: a systematic review. J Headache Pain 2013, 18;14(1):14. CrossRef
Headache Classification Committee of the International Headache Society (IHS): The International Classification of Headache Disorders, 3rd edition. Cephalalgia. beta version 2013, 33(9):629–808. CrossRef
- Diagnostic and therapeutic errors in cluster headache: a hospital-based study
Ilaria De Cillis
- Springer Milan
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II