Study of cluster headache: A hospital-based study

Abstract

Introduction:Cluster headache (CH) is uncommon and most painful of all primary headaches, and continues to be managed suboptimally because of wrong diagnosis. It needs to be diagnosed correctly and specifically treated. There are few studies and none from this region on CH.Materials and Methods:To study the detailed clinical profile of CH patients and to compare them among both the genders. Study was conducted at Mahatma Gandhi hospital, Jodhpur (from January 2011to December 2013). Study comprises 30 CH patients diagnosed according to International Headache Society guidelines (ICHD-II). Routine investigations and MRI brain was done in all patients. All measurements were reported as mean ± SD. Categorical variables were compared using the Chi-square test, and continuous variables were compared using Student's t-test. SPSS for Windows, Version 16.0, was used for statistical analyses with the significance level set at P = 0.05.Results:M: F ratio was 9:1. Age at presentation was from 22-60 years (mean - 38 years). Latency before diagnosis was 3 months-12 years (mean - 3.5 years). All suffered from episodic CH and aura was found in none. Pain was strictly unilateral (right-19, left-11), predominantly over temporal region-18 (60%). Pain intensity was severe in 27 (90%) and moderate in 3 (10%). Pain quality was throbbing in 12 (40%). Peak intensity was reached in 5 minutes-30 minutes and attack duration varied from 30 minutes to 3 hours (mean - 2.45 hours). Among autonomic features, conjunctival injection-23 (76.6%) and lacrimation-25 (83.3%) were most common. Restlessness during episode was found in 80%. CH duration varied from 10 days to 12 weeks. Circadian periodicity for attacks was noted in 24 (80%).Conclusion:Results are consistent with other studies on many accounts, but is different from Western studies with respect to low frequency of family history, chronic CH, restlessness and aura preceeding the attack. Detailed elicitation of history is paramount as misdiagnosis is common.

Cluster Headache Clinical Phenotypes: Tobacco Nonexposed (Never Smoker and No Parental Secondary Smoke Exposure as a Child) versus Tobacco‐Exposed: Results from the United States Cluster Headache Survey

“…Comparison to Other Studies.-There are very few CH population based studies that have looked at the nontobacco-exposed patient, and none have specifically investigated the complete nonexposed phenotype as parental exposure history has not been obtained in prior investigations. [5][6][7][8]11,[15][16][17][18][19] Of those studies that do mention a nonsmoking CH population, even fewer denote the specific clinical characteristics of that population. Thus, direct comparison to our data cannot be made, but inferences can be suggested.…”

“…Cluster headache (CH) is unique among all the primary headache syndromes based on its association with cigarette smoking/tobacco exposure . If a CH patient has no personal history of tobacco use, then there is typically a history of secondary cigarette smoke exposure as a child from the patient's parents .…”

“…Key words: cluster headache, tobacco, smoking, cigarette, secondary exposure Abbreviations: CH cluster headache, CNS central nervous system (Headache 2018;58:688-699) Cluster headache (CH) is unique among all the primary headache syndromes based on its association with cigarette smoking/tobacco exposure. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] If a CH patient has no personal history of tobacco use, then there is typically a history of secondary cigarette smoke exposure as a child from the patient's parents. 13 In many instances both scenarios exist, thus a history of double exposure.…”

Development and Evaluation of a Screening Tool to Aid the Diagnosis of Cluster Headache

“…These clinical characteristics had a high sensitivity (>90%) but with low specificity (<60%) which meant they were present in nearly all patients with CH and also present in many patients with migraine. Previous studies report variable results for the presence of restlessness during CH attacks (80% [49], 67.9% [10], 51% [50]). This could be due to differences in question phrasing even though the questionnaires used for data collection were not published [10,49,50].…”

“…Previous studies report variable results for the presence of restlessness during CH attacks (80% [49], 67.9% [10], 51% [50]). This could be due to differences in question phrasing even though the questionnaires used for data collection were not published [10,49,50]. According to previous reports, the presence of restlessness had a higher sensitivity in patients with chronic CH (sensitivity 100%, specificity 90%) than episodic CH (sensitivity 82%, specificity 92%) [51].…”