Chronobiology differs between men and women with cluster headache, clinical phenotype does not

Neurology ◽  
2017 ◽  
Vol 88 (11) ◽  
pp. 1069-1076 ◽  
Author(s):  
Nunu Lund ◽  
Mads Barloese ◽  
Anja Petersen ◽  
Bryan Haddock ◽  
Rigmor Jensen
Keyword(s):  
Cluster Headache ◽  
Clinical Characteristics ◽  
Clinical Phenotype ◽  
Correct Diagnosis ◽  
Diagnostic Delay ◽  
Headache Disorders ◽  
Structured Interviews ◽  
Secondary Sector ◽  
Headache Center

Objective:To describe differences between the sexes in the phenotype of cluster headache (CH) in a large, well-characterized clinical CH population.Methods:Patients from the Danish CH survey aged 18–65 years, diagnosed with CH according to International Classification of Headache Disorders, second edition, completed questionnaires and structured interviews.Results:A total of 351 patients with CH participated, with a male:female ratio of 2:1. The diurnal variation of attacks showed moments of peak prominence in men’s attack cycle to be advanced by 1 hour compared to women’s, despite no difference in self-reported bedtime or chronotype (p = 0.31). The onset of CH decreased with increasing age for both sexes. Diagnostic delay was numerically longer for men vs women (6.56 vs 5.50 years, p = 0.21); however, more women had previously been misdiagnosed (61.1% vs 45.5%, p < 0.01) and received the correct diagnosis at a tertiary headache center (38.8% vs 20.9%, p < 0.001). Only minor sex differences in clinical characteristics were found but chronic CH was more prevalent in women compared to men (44.0% vs 31.9%, p < 0.05).Conclusions:Despite a similar clinical phenotype, diurnal attack cycle is advanced by 1 hour in men with CH compared to women. Rhythmicity is a defining characteristic of CH and these findings suggest differences in the hypothalamus’ influence on attack occurrence between the sexes. In addition, women were more often misdiagnosed and diagnosis in the primary or secondary sector more often failed. Furthermore, women had chronic CH more frequently than men. A long diagnostic delay and frequent misdiagnosis emphasize the need for increased awareness of CH in both sexes.

A prospective comparative study and analysis of predictors of SUNA and SUNCT

Neurology ◽  
2019 ◽  
Vol 93 (12) ◽  
pp. e1127-e1137 ◽  
Author(s):  
Giorgio Lambru ◽  
Khadija Rantell ◽  
Andrew Levy ◽  
Manjit S. Matharu
Keyword(s):  
Confidence Interval ◽  
Clinical Characteristics ◽  
Clinical Phenotype ◽  
Diagnostic Category ◽  
Conjunctival Injection ◽  
Headache Disorders ◽  
The United Kingdom ◽  
Prospective Comparative Study ◽  
Headache Center

ObjectiveDespite the similar phenotypes, comparison between short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with autonomic features (SUNA) has hitherto not been possible due to the dearth of studies validating the phenotype of SUNA. Therefore, these 2 syndromes have been kept separate in the International Classification of Headache Disorders. The aim of this study is to characterize and compare the clinical phenotypes of large clinic-based cohorts of patients with SUNA and SUNCT.MethodsThe clinical phenotype of consecutive patients with SUNA identified from a single specialist headache center in the United Kingdom between 2007 and 2012 was studied and compared to that of patients with SUNCT.ResultsSixty-three patients with SUNA (18 male, 28.6%) and 70 patients with SUNCT (32 male, 35.7%) were included. The demographic and clinical characteristics of patients with SUNA were similar to those of patients with SUNCT. Ptosis and rhinorrhea were predictors of SUNCT. The corresponding odds ratios (ORs) (95% confidence interval) were 3.79 (1.64–8.77, p = 0.002) and 2.46 (1.09–5.59, p = 0.031), respectively. The presence of spontaneous only attacks was a predictor for SUNA (OR 2.58 [1.10–6.05], p = 0.029).ConclusionNo major clinical differences have emerged between SUNCT and SUNA, bar the fact that SUNCT is characterized by more prominent cranial autonomic features and triggerability. We propose that the 2 disorders be placed together in a single diagnostic category for which new diagnostic criteria are proposed.

Classification, diagnostic criteria, and epidemiology

2020 ◽  
pp. 177-181
Author(s):  
Thijs H. Dirkx ◽  
Peter J. Koehler
Keyword(s):  
Cluster Headache ◽  
Epidemiological Data ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Conjunctival Injection ◽  
Headache Disorders ◽  
Cranial Autonomic Symptoms ◽  
Unilateral Headache

The trigeminal autonomic cephalalgias (TACs), including cluster headache, paroxysmal hemicrania, SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing), SUNA (with cranial autonomic symptoms), and hemicrania continua, belong to the primary headaches. They are characterized by severe unilateral headache attacks in association with ipsilateral cranial autonomic features. Cluster headache is the most frequent of the TACs. The other TACs are rare, but epidemiological data are scarce and variable. The various types of TAC are distinguished not only by differences in attack frequency and duration, but also by differences with respect to treatment response. The typical headache syndromes, fulfilling the International Classification of Headache Disorders-3 criteria, have also been described in association with other disorders and imaging is required to exclude intracranial pathology in all newly diagnosed patients.

scholarly journals Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach

2020 ◽  
Vol 83 (1) ◽  
pp. 5-16 ◽  
Author(s):  
Laura Van Deun ◽  
Muriel de Witte ◽  
Thaïs Goessens ◽  
Stijn Halewyck ◽  
Marie-Christine Ketelaer ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Classification System ◽  
Facial Pain ◽  
Correct Diagnosis ◽  
Headache Disorders ◽  
Comprehensive Review ◽  
Pain Condition ◽  
Throat Pain ◽  
Generic Framework

Background: Facial pain, alone or combined with other symptoms, is a frequent complaint. Moreover, it is a symptom situated at, more than any other pain condition, a crosspoint where several disciplines meet, for example, dentists; manual therapists; ophthalmologists; psychologists; and ear-nose-throat, pain, and internal medicine physicians besides neurologists and neurosurgeons. Recently, a new version of the most widely used classification system among neurologists for headache and facial pain, the International Classification of Headache Disorders, has been published. Objective: The aims of this study were to provide an overview of the most prevalent etiologies of facial pain and to provide a generic framework for the neurologist on how to manage patients presenting with facial pain. Methods: An overview of the different etiologies of facial pain is provided from the viewpoint of the respective clinical specialties that are confronted with facial pain. Key message: Caregivers should “think outside their own box” and refer to other disciplines when indicated. If not, a correct diagnosis can be delayed and unnecessary treatments might be given. The presented framework is aimed at excluding life- or organ-threatening diseases, providing several clinical clues and indications for technical investigations, and ultimately leading to the correct diagnosis and/or referral to other disciplines.

Clinical Characteristics and Therapeutic Results in a Series of 68 Patients with Occipital Neuralgia

Pain Medicine ◽  
2019 ◽  
Author(s):  
Enrique Martínez-Pías ◽  
Javier Trigo-López ◽  
David García-Azorín ◽  
Aisling McGreal ◽  
Ángel Luis Guerrero Peral
Keyword(s):  
Clinical Characteristics ◽  
Negative Impact ◽  
International Headache Society ◽  
Tertiary Hospital ◽  
Occipital Neuralgia ◽  
Headache Disorders ◽  
Number Of Patients ◽  
Therapeutic Results ◽  
Prolonged Latency

Abstract Objective Cranial pain is a condition that has a negative impact on human lives, and occipital neuralgia is among its causes. This study aims to evaluate the clinical characteristics and therapeutic results of a series of patients with occipital neuralgia. Design Prospective registry (observational study). Settings Headache outpatient clinic in a tertiary hospital. Subjects Sixty-eight cases. Methods Demographic and nosological characteristics have been analyzed, as well as treatment response of occipital neuralgia. All patients were recruited between January 2008 and January 2018, and the diagnosis of occipital neuralgia was made according to the International Headache Society (International Classification of Headache Disorders) criteria being utilized at the time of diagnosis. Results Sixty-eight patients were diagnosed with occipital neuralgia, which corresponded to 1.2% of the total number of patients (5,515) who visited our Headache Unit during the aforementioned period. Fifty-four (79.4%) of them were female. Baseline pain was present in 62 (91.1%) patients, and exacerbations in 42 (61.8%). Latency from onset (range) was 27.7 ± 56.1 (1–360) months. Conclusions Occipital neuralgia is an uncommon disorder in the sample explored. The prolonged latency between the onset of symptoms and diagnosis suggests that there should be an increased awareness of this disorder.

scholarly journals Menstrual versus non-menstrual attacks of migraine without aura in women with and without menstrual migraine

Cephalalgia ◽  
2015 ◽  
Vol 35 (14) ◽  
pp. 1261-1268 ◽  
Author(s):  
Kjersti Grøtta Vetvik ◽  
Jūratė Šaltytė Benth ◽  
E Anne MacGregor ◽  
Christofer Lundqvist ◽  
Michael Bjørn Russell
Keyword(s):  
General Population ◽  
Migraine Without Aura ◽  
Clinical Characteristics ◽  
Repeated Measurements ◽  
Menstrual Migraine ◽  
Headache Disorders ◽  
Severe Nausea ◽  
Menstrual Cycles ◽  
Headache Diary

Objective The objective of this article is to compare clinical characteristics of menstrual and non-menstrual attacks of migraine without aura (MO), prospectively recorded in a headache diary, by women with and without a diagnosis of menstrual migraine without aura (MM) according to the International Classification of Headache Disorders (ICHD). Material and methods A total of 237 women from the general population with self-reported migraine in ≥50% of their menstrual periods were interviewed and classified by a physician according to the criteria of the ICHD II. Subsequently, all participants were instructed to complete a prospective headache diary for at least three menstrual cycles. Clinical characteristics of menstrual and non-menstrual attacks of MO were compared by a regression model for repeated measurements. Results In total, 123 (52%) women completed the diary. In the 56 women who were prospectively diagnosed with MM by diary, the menstrual MO-attacks were longer (on average 10.65 hours, 99% CI 3.17–18.12) and more frequently accompanied by severe nausea (OR 2.14, 99% CI 1.20–3.84) than non-menstrual MO-attacks. No significant differences between menstrual and non-menstrual MO-attacks were found among women with MO, but no MM. Conclusion In women from the general population, menstrual MO-attacks differ from non-menstrual attacks only in women who fulfil the ICHD criteria for MM.

Migraine and vertigo

2020 ◽  
pp. 128-137
Author(s):  
Yoon-Hee Cha
Keyword(s):  
Migraine Headache ◽  
Clinical Characteristics ◽  
Vestibular Migraine ◽  
Headache Disorders ◽  
Temporal Profile ◽  
Growing Body ◽  
Vestibular Symptoms ◽  
The Common ◽  
Treatment Responses

The phenomena of migraine headache and vertigo share many epidemiological, anatomical, and clinical characteristics. The historically parallel development of the neuroscience of each field has formally intersected in the development of consensus criteria for vestibular migraine and the inclusion of vestibular migraine in the International Classification of Headache Disorders. Differences exist in the temporal profile of head pain and vertigo as manifestations of migraine, which can obscure the association. However, the growing body of evidence on the common demographic, neurochemical signature, and treatment responses of pain and vestibular symptoms indicate that they exist as symptoms of a common syndrome, one which can only be fully understood by recognizing the significance of each kind of manifestation.

Evaluation of the new ICHD-III beta cluster headache criteria

Cephalalgia ◽  
2015 ◽  
Vol 36 (6) ◽  
pp. 547-551 ◽  
Author(s):  
IF de Coo ◽  
LA Wilbrink ◽  
J Haan ◽  
MD Ferrari ◽  
GM Terwindt
Keyword(s):  
Cohort Study ◽  
Cluster Headache ◽  
Response Rate ◽  
Headache Disorders ◽  
Facial Flushing ◽  
Cross Sectional ◽  
Web Based ◽  
Additional Value ◽  
Headache Patients

Aim In the revised criteria of the International Classification of Headache Disorders (ICHD-III beta) the following items are added to the diagnostic criteria of cluster headache: ipsilateral sensation of fullness in the ear and ipsilateral forehead/facial flushing. We evaluated the possible additional value of these symptoms for diagnosing cluster headache. Methods In this cross-sectional cohort study of (potential) cluster headache patients we investigated these additional symptoms using a Web-based questionnaire. Patients not fulfilling the ICHD-II criteria for cluster headache but fulfilling the ICHD-III beta criteria were interviewed. Results Response rate was 916/1138 (80.5%). Of all 573 patients with cluster headache according to ICHD-II criteria, 192 (33.5%) reported ipsilateral ear fullness and 113 (19.7%) facial flushing during attacks. There was no difference in reporting ipsilateral ear fullness and facial flushing between patients who received a diagnosis of cluster headache and patients who did not. None of the patients who did not fulfill all ICHD-II criteria could be categorized as cluster headache according to the ICHD-III beta criteria. Conclusion The results of this study do not support the addition of ear fullness and facial flushing to the new ICHD-III beta criteria.

scholarly journals Clinical features of chronic cluster headache based on the third edition of the International Classification of Headache Disorders: A prospective multicentre study

PLoS ONE ◽  
2019 ◽  
Vol 14 (8) ◽  
pp. e0221155 ◽  
Author(s):  
Soo-Jin Cho ◽  
Mi Ji Lee ◽  
Byung-Kun Kim ◽  
Heui-Soo Moon ◽  
Pil-Wook Chung ◽  
...  
Keyword(s):  
Multicentre Study ◽  
Cluster Headache ◽  
Clinical Features ◽  
Chronic Cluster Headache ◽  
International Classification ◽  
Headache Disorders ◽  
The Third ◽  
Prospective Multicentre Study

scholarly journals Grey Zones in the Diagnosis of Adult Migraine without Aura Based on the International Classification of Headache Disorders-Iii Beta: Exploring the Covariates of Possible Migraine without Aura

2015 ◽  
Vol 20 (1) ◽  
pp. e1-e7 ◽  
Author(s):  
Aynur Ozge ◽  
Elif Aydinlar ◽  
Bahar Tasdelen
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Criteria ◽  
Motion Sickness ◽  
Migraine Without Aura ◽  
Clinical Characteristics ◽  
Diagnostic Value ◽  
Infantile Colic ◽  
Headache Disorders ◽  
Final Version

BACKGROUND: Exploring clinical characteristics and migraine covariates may be useful in the diagnosis of migraine without aura.OBJECTIVE: To evaluate the diagnostic value of the International Classification of Headache Disorders (ICHD)-III beta-based diagnosis of migraine without aura; to explore the covariates of possible migraine without aura using an analysis of grey zones in this area; and, finally, to make suggestions for the final version of the ICHD-III.METHODS: A total of 1365 patients (mean [± SD] age 38.5±10.4 years, 82.8% female) diagnosed with migraine without aura according to the criteria of the ICHD-III beta were included in the present tertiary care-based retrospective study. Patients meeting all of the criteria of the ICHD-III beta were classified as having full migraine without aura, while those who did not meet one, two or ≥3 of the diagnostic criteria were classified as zones I, II and III, respectively. The diagnostic value of the clinical characteristics and covariates of migraine were determined.RESULTS: Full migraine without aura was evident in 25.7% of the migraineurs. A higher likelihood of zone I classification was shown for an attack lasting 4 h to 72 h (OR 1.560; P=0.002), with pulsating quality (OR 4.096; P<0.001), concomitant nausea/vomiting (OR 2.300; P<0.001) and photophobia/phonophobia (OR 4.865; P<0.001). The first-rank determinants for full migraine without aura were sleep irregularities (OR 1.596; P=0.005) and periodic vomiting (OR 1.464; P=0.026). However, even if not mentioned in ICHD-III beta, the authors determined that motion sickness, abdominal pain or infantile colic attacks in childhood, associated dizziness and osmophobia have important diagnostic value.CONCLUSIONS: In cases that do not fulfill all of the diagnostic criteria although they are largely consistent with the characteristics of migraine in clinical terms, the authors believe that a history of infantile colic; periodic vomiting (but not periodic vomiting syndrome); recurrent abdominal pain; the presence of motion sickness or vertigo, dizziness or osmophobia accompanying the pain; and comorbid atopic disorder are characteristics that should to be discussed and considered as additional diagnostic criteria (covariates) in the preparation of the final version of ICHD-III.

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