New insights in post-traumatic headache with cluster headache phenotype: a cohort study

Abstract

ObjectivesTo define the characteristics of post-traumatic headache with cluster headache phenotype (PTH-CH) and to compare these characteristics with primary CH.MethodsA retrospective study was conducted of patients seen between 2007 and 2017 in a headache centre and diagnosed with PTH-CH that developed within 7 days of head trauma. A control cohort included 553 patients with primary CH without any history of trauma who attended the headache clinic during the same period. Data including demographics, attack characteristics and response to treatments were recorded.ResultsTwenty-six patients with PTH-CH were identified. Multivariate analysis revealed significant associations between PTH-CH and family history of CH (OR 3.32, 95% CI 1.31 to 8.63), chronic form (OR 3.29, 95% CI 1.70 to 6.49), parietal (OR 14.82, 95% CI 6.32 to 37.39) or temporal (OR 2.04, 95% CI 1.10 to 3.84) location of pain, and presence of prominent cranial autonomic features during attacks (miosis OR 11.24, 95% CI 3.21 to 41.34; eyelid oedema OR 5.79, 95% CI 2.57 to 13.82; rhinorrhoea OR 2.65, 95% CI 1.26 to 5.86; facial sweating OR 2.53, 95% CI 1.33 to 4.93). Patients with PTH-CH were at a higher risk of being intractable to acute (OR 12.34, 95% CI 2.51 to 64.73) and preventive (OR 16.98, 95% CI 6.88 to 45.52) treatments and of suffering from associated chronic migraine (OR 10.35, 95% CI 3.96 to 28.82).ConclusionThis largest series of PTH-CH defines it as a unique entity with specific evolutive profile. Patients with PTH-CH are more likely to suffer from the chronic variant, have marked autonomic features, be intractable to treatment and have associated chronic migraine compared with primary CH.

Cluster Headache and Associated Risk Factors: A Systemic Review and Meta-Analysis

“…Eight studies among the selected studies reported the prevalence of gender discrimination in CH patients [2,8,19,[24][25][26][27][28]. The selected studies from 2004 to 2021 demonstrate the predominance of males among CH patients.…”

“…Head trauma and CH association was the least reported factor. Grangeon et al recently reported an extensive study on post-traumatic headache (PTH) in 553 CH patients [ 8 ]. This study revealed 26 patients with post-traumatic headache and linked this to the chronic and intractable CH form.…”

“…This also discriminates in disease presentation, severity, and pain intensity [ 7 ]. Post-traumatic headache (PTH) cluster headache has been linked with a chronic variant of CH disorder [ 8 ].…”

Diagnosis and management of traumatically induced hemicrania continua and neuropathic pain secondary to facial gun shot wound

“…Post-traumatic TAC is reported following a head injury. 3 The suggested mechanism for post-traumatic migraine is secondary to axonal injury or a shearing effect of the brainstem, even after mild or moderate injury. A physiological shift within the brainstem can lead to chronic migraine.…”

Peptides, MAbs, Molecules, Mechanisms, and More: Taking a Stab at Cluster Headache

“…In 1 study of the largest series of PTH‐CH patients, PTH‐CH patients vs CH patients were more likely to suffer from chronic cluster, prominent autonomic features, as well as intractable and comorbid chronic migraine. Several theories have been proposed for post‐traumatic CH, including the release of inflammatory mediators, sensitization of pain pathways, and hypothalamic trauma with subsequent dysfunction 50 …”