Study examines cluster headache

Texas: According to a study from the University of Texas Health Science Center in Houston, debilitating cluster headaches begin in childhood but are typically diagnosed in adulthood.

The research has been published in ‘Headache: The Journal of Head and Face Pain’.

A team of researchers led by Mark Burish, MD, PhD, assistant professor in the Vivian L. Smith Department of Neurourgery at McGovern Medical School at UTHealth Houston, conducted the Cluster Headache Questionnaire, an international, Internet-based study of 1,604 participants with cluster headaches.

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Cluster headache is a rare headache disorder that occurs in about one in every 1,000 individuals. They are extremely painful and occur in cyclical patterns known as cluster periods, with most attacks taking place at the same time each day. Cluster headaches are diagnosed as “episodic” when seizures occur in periods lasting between seven days and a year, and are separated by pain-free periods lasting three months or longer. Meanwhile, seizures occur in “chronic” cluster headaches for more than a year without remission or with remissions lasting less than three months.

The headache is similar to migraines, but there are some important differences. Unlike migraines, which can last a full day or potentially several days if left untreated, cluster headaches typically last anywhere from 15 to 180 minutes. Although it is uncommon to have more than one migraine a day, it is possible for someone to have up to eight cluster headaches over a 24-hour period. In addition, migraine pain may vary in location; in contrast, cluster headaches involve only one side of the head, typically at the temple or around the eye. Finally, people who have migraines tend to rest in a quiet, dark room, whereas people who have cluster headaches tend to become restless and often walk around the room.

There is extremely limited information on several characteristics of cluster headaches, namely cluster headaches in pediatric onset and comparative efficacy of cluster headache treatments.

“I hope this study will change the traditional thinking that cluster headaches only affect adult men,” said Burish, who is also at the University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences.

“Our study shows that it usually starts in childhood and that many children go years without the correct diagnosis, presumably they suffer all the time because they do not have the correct treatments,” Burish added.

Significantly, pediatric onset was found in 27.5 percent of study participants, but only 15.2 percent of pediatric onset participants were diagnosed before the age of 18.

Although the causes behind this trend remain unknown, Burish has come up with several theories based on conversations with pediatric neurologists, patients, and their parents. Family members and doctors do not recognize it because it is rare and patients are not referred to the appropriate specialists. Also, features of cluster headaches in children may be different than they are in adults, given that there are small differences between children and adults in other headaches such as migraines.

Burish said the study also revealed that women who have cluster headaches report higher pain intensity, more nausea and higher depression scores than men.

Other important study results include:

  1. While previous studies have shown that women were more likely to have migraines between the ages of 10 and 50, the reverse is true for cluster headaches: Men were more likely to have episodic cluster headaches between the ages of 10 and 50. The gender ratio was about the same for other ages.
  2. An overwhelming majority of respondents had at least one symptom with a reaction from the autonomic nervous system, such as red eyes or stuffy nose (99.0 percent) and had restlessness (96.6 percent), but many also had prototypical migraine features, including sensitivity to light and sound (50.1 per cent), pain aggravated by physical activity (31.4 per cent) or nausea and vomiting (27.5 per cent).
  3. Interestingly, the first-line medication for acute treatment (oxygen) and preventive treatment (calcium channel blockers) was perceived as significantly less effective in chronic cluster headache compared to episodic cluster headache.

In addition to these epidemiological data, Burish said the study revealed some minor goodies of information worthy of future research.

“Cluster headaches appear to start at a younger age in patients with a family history of cluster headaches compared to an older age in patients without a family history,” Burish said.

“In genetics, this is called ‘expectation’, suggesting that there may be one or more genes involved. Identifying these genes can be a major breakthrough for cluster headaches,” Burish added.

Other researchers included Hongyu Miao, PhD, associate professor in the Department of Biostatistics and Computer Science at the UTHealth School of Public Health; co-first authors Larry I. Schor, PhD, and Stuart M. Pearson, MA, with the University of West Georgia; and Robert E. Shapiro, MD, PhD, of the University of Vermont. Wei Zhang, PhD, former assistant professor in the Department of Biostatistics and Computer Science at the UTHealth School of Public Health, was also part of the research team.

The study received support from Autonomic Technologies, Inc. and Clusterbusters.

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