Cluster Headache Affects Women Seriously But Is Often Misdiagnosed

A large-scale analysis of gender differences in diagnosed patients in Sweden found that cluster headaches, which are typically more frequent in men, tend to be more severe and debilitating in women.

A detailed questionnaire from more than 800 patients showed that women were diagnosed with a subtype of chronic cluster headache more frequently than men (18% vs. 9%, P.=0.0002), Dr. Andrea Belin of the Karolinska Institutet, Stockholm, and neurology.

“Although the male-to-female ratio of cluster headaches has changed over the years, it is still considered a predominantly male disorder, and females with milder symptoms are more difficult to diagnose than males. Statement: “This may contribute to the increased incidence of chronic cluster headache in women.”

Active attacks of cluster headache last 15 to 180 minutes, with up to 8 attacks per day. Chronic cluster headache is defined as “recurring uninterrupted attacks of cluster headache for at least 1 year or short-term, symptom-free interruptions lasting less than 3 months”.

Women had longer seizures (P.=0.003) and used prophylactic treatment more frequently (60% vs 48%, P.= 0.0005), and the pain intensity was “equally intolerable” in both men and women, the authors said. Overall, emergency medication use was similar between men and women, and expect more frequent use of oxygen reported by women (P.=0.013). Women also experienced ptosis more commonly (61% vs. 47%, respectively; P.=0.0002) and restlessness (54% vs 46%, P.= 0.02).

Of note, women reported more frequent seizure circadian rhythms (74% vs. 63%, respectively; P.= 0.002).

Nausea alone, and migraine-associated nausea, was more common in women than in men. However, similar to the Swedish general population, fewer men than women had a concurrent diagnosis of migraine (12.5% ​​vs. 29.4%, P.<0.0001) and tension-type headache (44.3% vs 57.6%, P.=0.0002).

“This large study of rigorously diagnosed cluster headache patients mandates a rising index of suspicion for cluster headache in women and an awareness of women’s potential for more burdensome disease,” said Bronx. said Richard Lipton, M.D., Ph.D., of Albert Einstein College of Medicine in New York and UT Health Houston, Texas. Accompanying editorial.

Bellin and team echo previous research showing that the incidence of cluster headaches peaks between the ages of 20 and 30 in both men and women, and more broadly in women, and declines after age 50. It pointed out.Women with chronic cluster headache, no previously reported evidence bimodal pattern Speculation about the onset of the disease noted by Bellin and team hormonal involvement with cluster headaches.

More women than men had a first- or second-degree relative with cluster headache (15% vs. 7%, P.=0.0002). Compared with the general population, study participants had a higher mean body mass index (P.<0.0001), although this difference was significant only in men (P.= 0.009). Men also reported higher alcohol consumption than women (P.<0.0001) and were more likely to report that their cluster headaches were triggered by alcohol consumption (56.5% vs 40.5%)P= 0.001).

Triggers that occurred more frequently in women than men included weather/temperature or draft/gust changes (25.2% vs 11.3%, P.=0.0003) and sleep deprivation (14.7% vs 8.1%, P.= 0.037), the editors point out that these are also “well-known migraine triggers”.

“Cluster headaches are still often misdiagnosed in women, perhaps because they can resemble migraine headaches in some aspects.” It’s important to recognize when it presents itself, so that the most effective treatment can be given as soon as possible.”

The study included 874 people diagnosed with cluster headache according to the International Classification of Headache Disorders, 3rd Edition, identified from Swedish medical records from 2014 to 2020.

The mean ages for men and women were 51.3 and 49 years, respectively. 66% were male. The age of onset of cluster headache was similar between men and women, but fewer men had onset before age 20 (16.2% vs. 23.0%, P.= 0.020).

Participants completed detailed questionnaires about symptoms, medications, headache triggers, and lifestyle habits, and compared all variables with respect to gender, the authors said.

They noted that recall bias due to the use of self-reported data could occur in their study and this was a limitation.