Gender Ratio of Cluster Headache Over the Years: A Possible Role of Changes in Lifestyle

Abstract

Changes in the male-to-female (M/F) ratio of cluster headache (CH) over the years were investigated through a comparative analysis of the distribution of the disease by sex and decade of onset in 482 patients (374M and 108F). Variations over the last few decades were also investigated in the employment rate, level of school education, smoking habit, and coffee and alcohol intake of the population living in the same area as the CH patients. The M/F ratio has fallen from 6.2:1 for patients with CH onset before 1960, to 5.6:1, 4.3:1, 3.0:1, and 2.1:1 for patients with CH onset in the 1960s, 1970s, 1980s, and 1990s, respectively. Correspondingly, in those same decades, the M/F ratio has fallen from 2.6:1 to 2.4:1, 2.2:1, and 1.7:1, respectively, for the employment rate, and from 8.6:1 to 7.8:1, 3.3:1, 2.5:1, and 1.9:1 for the smoking habit. Such a close correlation suggests that the significant changes that have occurred over the last few decades in the lifestyle of both sexes--and particularly that of women--may have played a major role in altering the gender ratio of CH.

Cluster headache and lifestyle habits

“…These numbers were similar to those of a large Italian cohort of 482 CH patients recruited between 1976 and 1995 [7,8]. A history of smoking was reported by 81.9% (89.2% in men, 56.6% in women) [7].…”

“…A history of smoking was reported by 81.9% (89.2% in men, 56.6% in women) [7]. The numbers in this report and earlier studies appear very high compared with the studies published later (see following text).…”

“…Certain anthropometric features [4], personality traits [4,5], and lifestyle habits [6][7][8] have been described in patients with CH. Among the many unanswered questions surrounding CH, lifestyle habits have attracted the interest of many researchers in recent years, due to the debate about whether these habits can cause, trigger, or modify CH.…”

Cluster headache in childhood and adolescence: one-year prevalence in an out-patient population

“…A lifetime prevalence between 0.07% and 0.14% emerged in population-based studies [6][7][8][9][10] with a clear male preponderance which seems to decrease in the last decades [8,9]. This was attributed to changes in lifestyle factors over the years (such as employment rate and smoking habits), but this finding was not recently confirmed [22].…”

Cluster headache management and beyond

“…CH is a strictly lateralized and devastating periorbital headache, characterized with a very severe, excruciating pain and the presence of ipsilateral cranial autonomic symptoms, such as conjunctival injection, lacrimation and rhinorrhea. Lifetime prevalence is 1/1000 and a progressive reduction of the male/ female ratio over the past decades has been demonstrated and is now 2.1:1 [2]. The peculiar timing over the day (1 --8 attacks), in the entire active cluster period lasting 60 --90 days, and in the span of the year particularly with the seasonal changes, renders this headache unique, very easy to diagnose and differentiate from other TACs [1].…”