Primary and Secondary Chronic Cluster Headache: Two Separate Entities?

Abstract

The International Headache Society (IHS) classification divides chronic cluster headache (CH) into two subtypes: chronic CH unremitting from onset (CCHU) and chronic CH evolved from episodic (CCHE). The purpose of our study was to point out any similarities and differences between the two chronic CH subtypes and to determine whether or not they can be considered as two separate clinical entities. We reviewed data about 31 CCHE patients and 38 CCHU patients referred to the Parma Headache Centre between 1975 and 1999. Clinically, CCHE patients exhibited statistically significant differences from CCHU patients, i.e. earlier CH onset and duration of attacks varying more frequently between 120 and 180 min. From the point of view of lifestyle, heavy alcohol and coffee drinkers prevailed among CCHU patients, while CCHE patients were more frequently heavy smokers. Based on clinical features, it seems reasonable to suppose that chronic CH may occur as two distinct entities.

Chronic cluster headache: a review

“…The percentage of regular coffee drinkers was the same in both chronic conditions, however PCCH patients drank more cups of coffee a day [11].…”

“…There are also some differences in characteristics between PCCH and SCCH [11]. First, patients with PCCH more often reported right-sided pain than patients with In conclusion, there are some clinical differences between episodic and chronic CH and also between the two chronic forms.…”

“…In an Italian study, more male CCH patients smoked compared to ECH patients and the chronic patients also smoked more cigarettes a day [12]. Comparing the two chronic forms, there were more and also more heavy smokers in the SCCH group [11].…”

“…Also, head injury occurred more often on the same side as the headache in chronic patients. Head injury preceded the onset of CH more often in chronic patients [11] than episodic patients [13].…”

“…A male to female ratio of 3.6:1 was found for ECH and 4.2:1 for CCH [4]. Another study found a male to female ratio of 3.2:1 in PCCH and 2.4:1 in SCCH [11].…”