Headache Drugs Logo
Home | About Dr. Robbins | Archived Articles | Headache Books | Topic Index  

Back to List



Cluster Headache: A Prospective Clinical
Study with Diagnostic Implications
Bahra A, May A, Goadsby PJ
Posted December 2002  
Neurology 2002; 58:354-361

Background:  Cluster headache, when compared with migraine or tension-type headache, is an uncommon form of primary neurovascular headache. However, with a prevalence of approximately 0.1 percent and a lengthy history of disabling and distressing episodic pain, cluster headache is an important neurologic problem.

Methods:   Patients were recruited from a specialist clinic or from support groups. All patients had a detailed history taken by at least two physicians and were assigned diagnoses according to the International Headache Society Diagnostic Guidelines.

Results:   The pain characteristics were of a strictly unilateral, predominantly retro-orbital and temporal pain. Of the cranial autonomic features, lacrimation was the most common. Nausea, photophobia, and phonophobia often were noted, as was a sense of agitation or restlessness in 93 percent of patients. Typical migrainous aura was noted in 14 percent of this cohort. Most patients had episodic cluster headache, which was largely the same clinically as chronic cluster headache except for the persistence of attacks over time. The overall male-to-female ratio in this sample was 1.5:1, and this has decreased with time. Neither oral contraceptive use, menses, menopause, nor hormone replacement therapy had any consistent effect on cluster headache in women. Less than half of the patients had tried injectable sumatriptan, and many had not tried high-flow oxygen. Several unproven preventative agents that usually are used in migraine and an array of alternative therapies had been used; none of the latter was consistently effective.